1METROPOLITAN LIFE INSURANCE COMPANYRelativeCust Service Claim HandlingNoOther2012-06-12T00:00:002012-07-25T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life13191Ins Co - Licensed/ActiveOrganizationINDV2AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoInformation Furnished2012-06-21T00:00:002012-08-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG3BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoOther2012-06-11T00:00:002012-07-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationORG4BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoOther2012-06-28T00:00:002012-07-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationORG5CHARTER OAK FIRE INSURANCE COMPANY, THEInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Question of Fact2012-06-13T00:00:002012-07-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass2918Ins Co - Licensed/ActiveOrganizationINDV2012 NORTH TEXAS TORNADOES; ADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation; HAIL6REASSURE AMERICA LIFE INSURANCE COMPANYInsuredCash Value; MisrepresentationNoNo Jurisdiction2012-06-18T00:00:002012-07-30T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1228Ins Co - Licensed/ActiveOrganizationINDV7USAA GENERAL INDEMNITY COMPANYThird PartyUnsatisfactory Settle/OfferNoClaim Settled; Question of Fact2012-02-27T00:00:002012-07-02T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1276Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation8BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoCompany Position Upheld2012-06-19T00:00:002012-08-06T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV9PROPERTY AND CASUALTY INSURANCE COMPANY OF HARTFORDInsuredUnsatisfactory Settle/OfferNoComplainant Retained Attorney; Question of Fact; Information Furnished2011-10-03T00:00:002012-07-20T00:00:00Property and CasualtyHomeownersHomeowners8123Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; SUPPLEMENTARY PAYMENT9AMERICAS SERVICING CORPORATIONInsuredUnsatisfactory Settle/OfferYesFailure to Timely Respond2011-10-03T00:00:002012-07-20T00:00:00Property and CasualtyHomeownersHomeowners66259Mortgage LenderOrganizationINDVGR-Claim Evaluation; SUPPLEMENTARY PAYMENT10ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYAttorneyNon-Disclosure Of CoverageYesInformation Furnished2012-06-15T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDVCREDIT REPORT12HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.RelativeDenial Of ClaimNoContract Language/Legal Issue2012-06-18T00:00:002012-07-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HGR Elected Official; Insured27417Ins Co - Licensed/ActiveOrganizationINDV13OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredCancellationNoCompany Position Upheld; Policy Not In Force2012-04-13T00:00:002012-07-20T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDV13ROMERO INSURANCE AGENCY, LLCInsuredCancellationNoInformation Furnished2012-04-13T00:00:002012-07-20T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency43328Insurance AgencyOrganizationINDV14HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.InsuredProvider Ntwk DisclosureNoInformation Furnished2012-06-18T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H27417Ins Co - Licensed/ActiveOrganizationINDV14CASILLAS, LISA MICHELLEInsuredUnauthorized ActsNoContract Language/Legal Issue2012-06-18T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H740139AgentIndividualINDV15ACCEPTANCE CASUALTY INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Additional Payment Expected; Question of Fact2012-06-05T00:00:002012-07-27T00:00:00Property and CasualtyHomeownersHomeownersThird Party Admin-Non Licensed8207Ins Co - Licensed/ActiveOrganizationINDVFOUNDATION ; GR-Claim Evaluation; WATER DAMAGE16GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoClaim Settled; Question of Fact2011-11-21T00:00:002012-07-16T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent2486Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DIMINISHED VALUE; GR-Claim Evaluation17HUMANA INSURANCE COMPANYInsuredPremium NoticeNoPremium Refunded2012-06-14T00:00:002012-08-27T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1040Ins Co - Licensed/ActiveOrganizationINDV18ALLSTATE TEXAS LLOYD'SInsuredCust Service Claim HandlingNoAdditional Payment Expected2012-06-11T00:00:002012-07-12T00:00:00Property and CasualtyHomeownersHomeowners3721Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation18CHAPMAN, JERRY DInsuredOtherNo2012-06-11T00:00:002012-07-12T00:00:00Property and CasualtyHomeownersHomeowners911719AgentIndividualINDVGR-Claim Evaluation19GERMANIA INSURANCE COMPANYInsuredNon-RenewalNoInformation Furnished2012-06-12T00:00:002012-08-01T00:00:00Property and CasualtyHomeownersHomeowners1159Ins Co - Licensed/ActiveOrganizationINDVBREED OF DOG20RLI INSURANCE COMPANYAttorneyDenial Of ClaimNoQuestion of Fact; Information Furnished2012-05-07T00:00:002012-07-16T00:00:00Property and CasualtyMiscellaneousFidelity & Surety1686Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation21ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoQuestion of Fact2012-05-15T00:00:002012-07-02T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDVCOMPARATIVE NEGLIGENCE; GR-Claim Evaluation22ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyDenial Of ClaimYesAdditional Payment Expected2012-06-12T00:00:002012-07-11T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent936Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING23ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoContract Language/Legal Issue; Additional Payment Expected; Question of Fact2012-06-14T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDVTOTAL LOSS24ASI LLOYDSInsuredDenial Of ClaimNoInformation Furnished2012-06-14T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners14728Ins Co - Licensed/ActiveOrganizationINDVWATER DAMAGE25OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoAdditional Monies Received; Claim Settled; Question of Fact2012-03-14T00:00:002012-07-18T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVLOSS OF USE26STANDARD LIFE AND CASUALTY INSURANCE COMPANYInsuredDenial Of ClaimNoPremium Refunded; Information Furnished; Contract Language/Legal Issue2012-05-31T00:00:002012-07-23T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H105Ins Co - Licensed/ActiveOrganizationINDVEMERGENCY CARE27STARR INDEMNITY & LIABILITY COMPANYInsuredDelays (Claims Handling); Pre-Existing ConditionNoNo Jurisdiction2012-05-31T00:00:002012-09-28T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeThird Party Admin-Licensed997Ins Co - Licensed/ActiveOrganizationINDV28CIGNA HEALTHCARE OF TEXAS, INC.ProviderDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-06-29T00:00:002012-09-19T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured8294Health Maintenance OrgOrganizationORGGR-Claim Evaluation29KING-PHILLIPS INSURANCE AGENCY INCInsuredAgent Handling; Delays (Policyholder Service); Refund Of PremiumYesInformation Furnished; Referred for Disciplinary Actn; Additional Monies Received2012-06-11T00:00:002012-09-10T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent; Associated Subject Agency; Insured6760Insurance AgencyOrganizationINDVROOF29CATLIN INSURANCE COMPANY (UK) LTD.InsuredCancellationNoInformation Furnished2012-06-11T00:00:002012-09-10T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent; Associated Subject Agency; Insured54370Ins Co - Surplus LinesOrganizationINDVROOF29RODRIGUEZ, LORENZO ROBERTInsuredAgent HandlingYesReferred for Disciplinary Actn2012-06-11T00:00:002012-09-10T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent; Associated Subject Agency; Insured844688AgentIndividualINDVROOF30TIME INSURANCE COMPANYInsuredDenial Of ClaimNoPremium Refunded2012-06-05T00:00:002012-08-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1374Ins Co - Licensed/ActiveOrganizationINDV30FREEDOM LIFE INSURANCE COMPANY OF AMERICAInsuredPre-Existing ConditionNoAdditional Monies Received2012-06-05T00:00:002012-08-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2855Ins Co - Licensed/ActiveOrganizationINDV30OCHUKO, ANTHONY TOBOREInsuredPre-Existing ConditionNoInformation Furnished2012-06-05T00:00:002012-08-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&H964110AgentIndividualINDV31CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderPre-Existing ConditionNoInformation Furnished; Additional Monies Received2012-06-12T00:00:002012-07-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851ProviderOrganizationORGGR-Claim Evaluation32VOYAGER INDEMNITY INSURANCE COMPANYInsuredDelays (Claims Handling)YesAdditional Monies Received; Information Furnished; Referred for Disciplinary Actn2012-06-11T00:00:002012-08-01T00:00:00Property and CasualtyHomeownersHomeownersInsured51916Ins Co - Surplus LinesOrganizationINDVACV; ADJUSTER'S HANDLING; HAIL; ROOF; TOTAL LOSS33SANTA FE AUTO INSURANCE COMPANYInsuredOther; Premium NoticeNoCompany Position Upheld; Information Furnished2012-06-11T00:00:002012-08-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass27766Ins Co - Licensed/ActiveOrganizationINDV34SOUTHERN COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished2012-06-22T00:00:002012-12-27T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; GR Elected Official1583Ins Co - Licensed/ActiveOrganizationINDV35CONNECTICUT GENERAL LIFE INSURANCE COMPANY OF EUROPEProviderDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-06-11T00:00:002012-07-16T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured67093OtherOrganizationORGGR-Claim Evaluation36AAA TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished2012-06-05T00:00:002012-07-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person2286Ins Co - Licensed/ActiveOrganizationINDVACV; DAMAGE DISPUTE; GR-Claim Evaluation; TOTAL LOSS37CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoAdditional Payment Expected; No Jurisdiction2012-06-11T00:00:002012-08-08T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORGBUNDLING; GR-Claim Evaluation38ALLSTATE INSURANCE COMPANYThird PartyCust Service Claim Handling; Unsatisfactory Settle/OfferNoClaim Settled; Additional Monies Received2012-06-08T00:00:002012-07-30T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured168Ins Co - Licensed/ActiveOrganizationINDVACV; ADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation; TOTAL LOSS39LIBERTY LLOYDS OF TEXAS INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling); Denial Of ClaimNoInformation Furnished; Company Position Upheld2012-06-11T00:00:002012-08-21T00:00:00Property and CasualtyHomeownersHomeowners11084Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; BURDEN OF PROOF; COVERAGE DISPUTE; DAMAGE DISPUTE; GR-Claim Evaluation; POLICY EXCLUSION; WATER DAMAGE40LINCOLN NATIONAL LIFE INSURANCE COMPANY, THEThird PartyCash ValueNo2012-06-27T00:00:002012-08-21T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2172Ins Co - Licensed/ActiveOrganizationORG40ATHENE ANNUITY & LIFE ASSURANCE COMPANYThird PartyCash ValueNoInformation Furnished2012-06-27T00:00:002012-08-21T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life3023Ins Co - Licensed/ActiveOrganizationORG40BANKERS LIFE AND CASUALTY COMPANYThird PartyCash ValueNo2012-06-27T00:00:002012-08-21T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life3030Ins Co - Licensed/ActiveOrganizationORG41BOWENS, SOLOMON ERICConsumer (Non-Insured)Agent Handling; Misrepresentation; TwistingNoInsufficient Information; Other2012-05-17T00:00:002012-08-20T00:00:00Property and CasualtyHomeownersHomeowners302366AgentIndividualINDV42HOME STATE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferYesClaim Settled2012-05-10T00:00:002012-07-23T00:00:00Property and CasualtyAutomobileIndividual Private Pass2362Ins Co - Licensed/ActiveOrganizationINDVLOSS OF USE; REPLACEMENT VEHICLE43TEXAS FARMERS INSURANCE COMPANYInsuredRefund Of PremiumNoContract Language/Legal Issue; Information Furnished; Question of Fact2012-04-13T00:00:002012-11-27T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF44SOUTHERN COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of Claim; Unsatisfactory Settle/OfferNoAdditional Monies Received; Company Position Upheld; Information Furnished2012-05-24T00:00:002012-08-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company1583Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; REPLACEMENT VEHICLE45BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-06-21T00:00:002012-08-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company; Insured10047Ins Co - Licensed/ActiveOrganizationORGBUNDLING; GR-Claim Evaluation46NATIONAL LLOYDS INSURANCE COMPANYInsuredDenial Of ClaimYesInformation Furnished; Additional Monies Received; Claim Settled2012-06-06T00:00:002012-07-30T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency; Associated Subject Company1914Ins Co - Licensed/ActiveOrganizationINDVAPPRAISAL; GR-Claim Evaluation; HAIL; ROOF47PHYSICIANS MUTUAL INSURANCE COMPANYConsumer (Non-Insured)XX-Coverage QuestionNoContract Language/Legal Issue; Insufficient Information2012-06-18T00:00:002012-09-24T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1787Ins Co - Licensed/ActiveOrganizationINDV48COMPANION LIFE INSURANCE COMPANYInsuredDelays (Claims Handling)NoClaim Settled; Information Furnished2012-06-18T00:00:002012-07-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&H3710Ins Co - Licensed/ActiveOrganizationINDV48ADMINISTRATIVE CONCEPTS, INC.InsuredDelays (Claims Handling)NoInformation Furnished2012-06-18T00:00:002012-07-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&H50662Third Party AdministratorsOrganizationINDV49HUMANA INSURANCE COMPANYProviderDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received; Information Furnished2012-06-21T00:00:002012-08-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORGEMERGENCY CARE; GR-Claim Evaluation50NATIONAL LLOYDS INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished2012-06-18T00:00:002012-09-20T00:00:00Property and CasualtyHomeownersHomeowners1914Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation50KILPATRICK, JANIS SCOBEEInsuredNon-Disclosure Of CoverageNoQuestion of Fact; Information Furnished2012-06-18T00:00:002012-09-20T00:00:00Property and CasualtyHomeownersHomeowners293289AgentIndividualINDVGR-Claim Evaluation51TEXAS FAIR PLAN ASSOCIATIONThird PartyDelays (Claims Handling)NoInformation Furnished2012-05-29T00:00:002012-08-26T00:00:00Property and CasualtyHomeownersHomeowners18208Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING52AETNA LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished2012-06-18T00:00:002012-08-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDV54STATE FARM LLOYDSOtherDenial Of Claim; Unsatisfactory Settle/OfferNoCompany Position Upheld; Contract Language/Legal Issue2012-05-17T00:00:002012-08-09T00:00:00Property and CasualtyHomeownersHomeownersInsured3105Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; ROOF55BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-06-21T00:00:002012-08-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORGEMERGENCY CARE; GR-Claim Evaluation56WELLINGTON INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoAdditional Payment Expected; Company Position Upheld; Information Furnished2012-03-07T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners18251Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; DEPRECIATION; GR-Claim Evaluation57NATIONAL SPECIALTY INSURANCE COMPANYInsuredDelays (Claims Handling)NoAdditional Monies Received; Information Furnished; Contract Language/Legal Issue2011-09-14T00:00:002012-08-02T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person2281Ins Co - Licensed/ActiveOrganizationINDV58BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredOther; Refusal to InsureNoContract Language/Legal Issue2012-06-06T00:00:002013-02-14T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationINDV59PRUDENTIAL INSURANCE COMPANY OF AMERICA, THEConsumer (Non-Insured)OtherYesCorrective Action Taken; Information Furnished2012-05-02T00:00:002012-10-11T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1729Ins Co - Licensed/ActiveOrganizationINDV59DUNN, RONALD TERRYConsumer (Non-Insured)OtherYesInformation Furnished2012-05-02T00:00:002012-10-11T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life5529AgentIndividualINDV61GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyDenial Of ClaimYesQuestion of Fact; Additional Monies Received2011-09-21T00:00:002012-07-26T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2486Ins Co - Licensed/ActiveOrganizationINDV62MEDCO HEALTH, L.L.C.InsuredUnsatisfactory Settle/OfferNoClaim Settled2012-06-18T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H54629Ins Co - Licensed/ActiveOrganizationINDVPRESCRIPTION63TEXAS FAIR PLAN ASSOCIATIONInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Claim Settled2011-12-21T00:00:002012-07-24T00:00:00Property and CasualtyHomeownersHomeowners18208Texas Fair Insurance PlanOrganizationINDV64AMERICAN FAMILY LIFE ASSURANCE COMPANY OF COLUMBUSInsuredRefund Of PremiumNoPremium Refunded2012-06-21T00:00:002012-08-07T00:00:00Life, Accident and HealthLife & AnnuityGroup AnnuitiesAssociated Agent; Insured2655Ins Co - Licensed/ActiveOrganizationINDVRESCISSION64COLLINS, KRISTY MARIEInsuredAgent Handling; MisrepresentationNoQuestion of Fact2012-06-21T00:00:002012-08-07T00:00:00Life, Accident and HealthLife & AnnuityGroup AnnuitiesAssociated Agent; Insured845984AgentIndividualINDVRESCISSION65IDS PROPERTY CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Claim Settled2012-06-07T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass3610Ins Co - Licensed/ActiveOrganizationINDV66TEXAS HEALTH INSURANCE POOLInsuredRecoupment Of Claims PaymentYesCorrective Action Taken; Information Furnished; Additional Payment Expected2012-06-18T00:00:002013-02-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&H9031Ins Co - Licensed/ActiveOrganizationINDV66BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredRecoupment Of Claims PaymentYes2012-06-18T00:00:002013-02-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV67WELLINGTON INSURANCE COMPANYInsuredCancellationNoCompany Position Upheld2012-06-14T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners18251Ins Co - Licensed/ActiveOrganizationINDV68TREVINO, ISRAEL JGR Other Government OfficeMisleading Advertising; XX-Othr Violatn of Ins Law/RegYesOther2012-05-29T00:00:002012-08-20T00:00:00Property and CasualtyHomeownersHomeowners428540AgentIndividualORGADVERTISING69NEW HAMPSHIRE INSURANCE COMPANYDWC AustinDelays (Claims Handling)NoInformation Furnished2012-06-25T00:00:002012-09-21T00:00:00Workers' CompensationMiscellaneousWorkers' Compensation1883DWC HCP FacilityOrganizationORG70NATIONAL SECURITY FIRE & CASUALTY COMPANYInsuredDelays (Claims Handling)YesReferred for Disciplinary Actn2012-04-11T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners55805Ins Co - Surplus LinesOrganizationINDV71OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received; Claim Settled2012-04-26T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDV73PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferYesAdditional Monies Received; Corrective Action Taken2012-06-18T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDV74QUANTUM CAPITAL INVESTMENTConsumer (Non-Insured)OtherNoInsufficient Information2012-06-08T00:00:002012-08-08T00:00:00Property and CasualtyMiscellaneousNo Line Specified67291No Entity Complained AgainstOrganizationINDV75STATE FARM LLOYDSInsuredPremium and RatingNoRate Problem Resolved2012-06-19T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDV76PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredRefund Of PremiumNoInformation Furnished2012-06-07T00:00:002012-08-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDV77UPMC Health PlanProviderUnsatisfactory Settle/OfferNoClaim Settled2012-05-21T00:00:002012-09-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&H66326OtherOrganizationORGGR-Claim Evaluation78TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredUnsatisfactory Settle/OfferNoInformation Furnished2012-06-08T00:00:002012-09-19T00:00:00Property and CasualtyMiscellaneousP & C Misc1444TWIAOrganizationINDV79AETNA LIFE INSURANCE COMPANYContracted ProviderClaim Recoding/Bundling; XX-RecoupmentNoInformation Furnished; Claim Settled; Additional Monies Received2012-05-31T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured245Ins Co - Licensed/ActiveOrganizationINDV80TEXAS FAIR PLAN ASSOCIATIONInsuredXX-Othr Violatn of Ins Law/RegNoCancellation Withdrawn2012-06-11T00:00:002012-11-27T00:00:00Property and CasualtyMiscellaneousP & C Misc18208TWIAOrganizationINDV81PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and RatingNoPremium Refunded2012-06-06T00:00:002012-08-20T00:00:00Property and CasualtyAutomobileBusiness Automobile1708Ins Co - Licensed/ActiveOrganizationORGAGENT'S FEE; COVERAGE DISPUTE; UNDERWRITING CRITERIA81INSURANCE 3 GROUP INCInsuredPremium and RatingNo2012-06-06T00:00:002012-08-20T00:00:00Property and CasualtyAutomobileBusiness Automobile14548Insurance AgencyOrganizationORGAGENT'S FEE; COVERAGE DISPUTE; UNDERWRITING CRITERIA81BOYD, KYLE SCOTTInsuredAgent Handling; Excess Comp W/O Agreement; MisrepresentationNoAdditional Payment Expected2012-06-06T00:00:002012-08-20T00:00:00Property and CasualtyAutomobileBusiness Automobile298599AgentIndividualORGAGENT'S FEE; COVERAGE DISPUTE; UNDERWRITING CRITERIA82NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA.Third PartyUnsatisfactory Settle/OfferNoQuestion of Fact; Complainant Retained Attorney; Information Furnished2012-06-04T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileBusiness Automobile1931Ins Co - Licensed/ActiveOrganizationINDV83BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-06-25T00:00:002012-07-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation84AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling); Denial Of ClaimNoNo Jurisdiction2012-06-21T00:00:002012-07-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation85FUSCO, ANTHONY VAgentXX-Othr Violatn of Ins Law/RegYesOther2012-06-08T00:00:002012-10-03T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines488312AgentIndividualORG86USAA CASUALTY INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld2012-06-11T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass3607Ins Co - Licensed/ActiveOrganizationINDVREPAIR CHOICE87ACCC INSURANCE COMPANYInsuredDenial Of ClaimNoPolicy Not In Force; Information Furnished2012-06-07T00:00:002012-08-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDV88ASSURITY LIFE INSURANCE COMPANYInsuredDelays (Claims Handling); Premium and RatingNoInformation Furnished; Company Position Upheld2012-05-16T00:00:002012-07-16T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2533Ins Co - Licensed/ActiveOrganizationINDV89UNDERWRITERS AT LLOYD'S, LONDONInsuredDenial Of ClaimNoCompany Position Upheld2012-03-21T00:00:002012-07-19T00:00:00Property and CasualtyAutomobileTruckers Policy55949Ins Co - Licensed/ActiveOrganizationINDVEXAM UNDER OATH; UNDERWRITING CRITERIA89DAVIDSON, DANIEL ANTHONYInsuredOtherYes2012-03-21T00:00:002012-07-19T00:00:00Property and CasualtyAutomobileTruckers Policy458078AgentIndividualINDVEXAM UNDER OATH; UNDERWRITING CRITERIA90INVESTORS LIFE INSURANCE COMPANY OF NORTH AMERICAInsuredPremium NoticeNoInformation Furnished; Contract Language/Legal Issue2012-07-02T00:00:002012-08-24T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2572Ins Co - Licensed/ActiveOrganizationINDV91TEXAS FAIR PLAN ASSOCIATIONInsuredCancellationNoCancellation Withdrawn2012-06-11T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners18208TWIAOrganizationINDV92LEXINGTON INSURANCE COMPANYInsuredRefund Of PremiumYesPremium Refunded; Information Furnished2012-06-04T00:00:002012-09-21T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines48870Ins Co - Licensed/ActiveOrganizationINDV92SIDDIQUI, FARRUKHInsuredRefund Of PremiumYesFailure to Timely Respond2012-06-04T00:00:002012-09-21T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines819721AgentIndividualINDV93CAPITOL COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredPremium and RatingNoFailure to Timely Respond; Information Furnished; Policy Not In Force2012-01-25T00:00:002012-09-06T00:00:00Property and CasualtyHomeownersHomeowners2992Ins Co - Licensed/ActiveOrganizationINDV94GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; Company Position Upheld2012-06-08T00:00:002012-07-31T00:00:00Property and CasualtyAutomobileMotorhome/Recreational Veh2486Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE95BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoInformation Furnished; Additional Monies Received2012-06-21T00:00:002012-07-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation96DESERET MUTUAL BENEFIT ADMINISTRATORSRelativeCancellationNoNo Jurisdiction2012-04-13T00:00:002012-07-18T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured66338Third Party AdministratorsOrganizationINDV97BALBOA INSURANCE COMPANYInsuredRefund Of PremiumNoInformation Furnished; Premium Refund2012-06-11T00:00:002012-07-26T00:00:00Property and CasualtyHomeownersHomeowners3083Ins Co - Licensed/ActiveOrganizationINDV98HUMANA INSURANCE COMPANYProviderDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-06-18T00:00:002012-07-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationINDVBUNDLING99ACE AMERICAN INSURANCE COMPANYPhysicianDelays (Claims Handling)NoClaim Settled2012-05-22T00:00:002012-08-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2327Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation99BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONPhysicianDelays (Claims Handling)No2012-05-22T00:00:002012-08-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation99ADMINISTRATIVE CONCEPTS, INC.PhysicianDelays (Claims Handling)No2012-05-22T00:00:002012-08-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured50662Third Party AdministratorsOrganizationORGGR-Claim Evaluation100PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld2012-06-11T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVREPAIR CHOICE102PENNSYLVANIA MANUFACTURERS' ASSOCIATION INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished2012-06-11T00:00:002012-07-18T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines1821Ins Co - Licensed/ActiveOrganizationINDV102BADER, ROBERT NATHANInsuredUnsatisfactory Settle/OfferNoInformation Furnished2012-06-11T00:00:002012-07-18T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines92738AgentIndividualINDV103TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld2012-04-13T00:00:002012-11-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass1450Ins Co - Licensed/ActiveOrganizationINDV104PROGRESSIVE ADVANCED INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld; Additional Payment Expected2012-06-18T00:00:002012-09-19T00:00:00Property and CasualtyMiscellaneousP & C Misc19817Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation105TIME INSURANCE COMPANYInsuredClaimant FraudNoInformation Furnished2012-06-25T00:00:002012-08-02T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1374Ins Co - Licensed/ActiveOrganizationINDV106TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredAgent HandlingNoInformation Furnished2012-05-07T00:00:002012-09-11T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines1444TWIAOrganizationINDV106ALEMAN, JAMES DARRYLInsuredAgent Handling; ConversionYesReferred for Disciplinary Actn; Information Furnished2012-05-07T00:00:002012-09-11T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines702891AgentIndividualINDV107HUMANA INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Additional Monies Received2012-06-20T00:00:002012-08-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORGEMERGENCY CARE108ALLIANT INSURANCE SERVICES, INC.Third PartyDelays (Claims Handling)NoContract Language/Legal Issue2012-04-26T00:00:002012-07-23T00:00:00Property and CasualtyLiabilityXX-GeneralInsured18523Insurance AgencyOrganizationORG108CENTURY SURETY COMPANYThird PartyDelays (Claims Handling)NoContract Language/Legal Issue; Information Furnished2012-04-26T00:00:002012-07-23T00:00:00Property and CasualtyLiabilityXX-GeneralInsured51851Ins Co - Licensed/ActiveOrganizationORG109AMERICAN BANKERS INSURANCE COMPANY OF FLORIDAInsuredDelays (Claims Handling); Denial Of ClaimNoCompany Position Upheld2012-04-23T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners176Ins Co - Licensed/ActiveOrganizationINDV110AMERICO FINANCIAL LIFE AND ANNUITY INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished; Contract Language/Legal Issue2012-05-31T00:00:002012-08-06T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2897Ins Co - Licensed/ActiveOrganizationINDV111MGA INSURANCE COMPANY, INC.InsuredDelays (Claims Handling)YesClaim Settled2012-06-27T00:00:002012-08-14T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person812Ins Co - Licensed/ActiveOrganizationINDV112INFINITY COUNTY MUTUAL INSURANCE COMPANYInsuredCancellation; Denial Of ClaimNoCancel/Non-Renewal Upheld; Premium Refunded; Company Position Upheld2012-06-15T00:00:002012-08-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass1197Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE113UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.InsuredDenial Of ClaimNoNo Jurisdiction2012-06-18T00:00:002012-07-17T00:00:00Health Maintenance OrgAccident and HealthGroup A&H3425Ins Co - Licensed/ActiveOrganizationINDV114GEICO INDEMNITY COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received; Corrective Action Taken; Additional Payment Expected2012-06-27T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private PassCorrespondent Person2785Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING115CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-06-06T00:00:002012-07-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation116SOUTHERN COUNTY MUTUAL INSURANCE COMPANYInsuredAssignment of Benefits; Delays (Claims Handling)NoInformation Furnished; Company Position Upheld2012-03-13T00:00:002012-07-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass1583Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; CHIROPRACTIC; GR-Claim Evaluation117SUNAMERICA ANNUITY AND LIFE ASSURANCE COMPANYInsuredMisrepresentationNoQuestion of Fact; Contract Language/Legal Issue2012-06-18T00:00:002012-08-14T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities3497Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN117LANDIS, KEVIN MICHAELInsuredMisrepresentationNoQuestion of Fact; Contract Language/Legal Issue2012-06-18T00:00:002012-08-14T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities374146AgentIndividualINDVSENIOR CITIZEN118ALLSTATE INDEMNITY COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Question of Fact2012-04-20T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass167Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING119OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDelays (Claims Handling)NoClaim Settled; Additional Monies Received2012-06-18T00:00:002012-08-23T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING120Office of Group BenefitsProviderDenial Of ClaimNoClaim Settled; Other2012-05-18T00:00:002012-12-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured66346OtherOrganizationORGGR-Claim Evaluation121SAFECO INSURANCE COMPANY OF INDIANAInsuredDelays (Claims Handling)YesInformation Furnished; Claim Settled2012-06-22T00:00:002012-07-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass2496Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING122GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredDenial Of ClaimYesAdditional Monies Received2012-06-18T00:00:002012-08-08T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDV123METROPOLITAN CASUALTY INSURANCE COMPANYThird PartyCust Service Claim HandlingNoRecord Only2012-06-08T00:00:002012-08-07T00:00:00Property and CasualtyAutomobileIndividual Private Pass1245Ins Co - Licensed/ActiveOrganizationINDV124RELIABLE LIFE INSURANCE COMPANY, THEInsuredDenial Of ClaimNoInformation Furnished2012-06-18T00:00:002012-07-27T00:00:00Property and CasualtyHomeownersHomeowners1704Ins Co - Licensed/ActiveOrganizationINDV125UNION BANKERS INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue2012-06-21T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1315Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation126SCOTT AND WHITE HEALTH PLANInsuredUnsatisfactory Settle/OfferNo2012-06-07T00:00:002012-08-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company788Ins Co - Licensed/ActiveOrganizationINDV126BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredClaim Recoding/BundlingNoRecord Only2012-06-07T00:00:002012-08-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company10047Ins Co - Licensed/ActiveOrganizationINDV127AETNA LIFE INSURANCE COMPANYRelativeDelays (Claims Handling); Unsatisfactory Settle/OfferNoNo Jurisdiction2012-06-21T00:00:002012-07-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured245Ins Co - Licensed/ActiveOrganizationINDVAUTISM SPECTRUM DISORDER128CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-06-18T00:00:002012-08-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORG129TEXAS FARM BUREAU CASUALTY INSURANCE COMPANYAttorneyDelays (Claims Handling); Liability DisputeNoNo Jurisdiction2012-06-27T00:00:002012-07-26T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Associated Subject Person28440Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation130SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.InsuredDelays (Claims Handling)NoInformation Furnished2012-05-17T00:00:002012-07-26T00:00:00Property and CasualtyLiabilityXX-General34661Third Party AdministratorsOrganizationINDV130LEXINGTON INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-05-17T00:00:002012-07-26T00:00:00Property and CasualtyLiabilityXX-General48870Ins Co - Licensed/ActiveOrganizationINDV131FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoQuestion of Fact2012-05-24T00:00:002012-07-09T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2623Ins Co - Licensed/ActiveOrganizationINDV132INTERNATIONAL MEDICAL ADMINISTRATORS, INC.ProviderUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-06-27T00:00:002012-08-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured21814Ins Co - Licensed/ActiveOrganizationINDV133TEXAS HEALTH INSURANCE POOLPhysicianDenial Of ClaimNoAdditional Monies Received; Information Furnished2012-06-11T00:00:002012-08-07T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H9031Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation133BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONPhysicianUnfair Discrim-Clms HandlingNoNo Jurisdiction2012-06-11T00:00:002012-08-07T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Self-Funded / ErisaOrganizationINDVGR-Claim Evaluation135US LLOYDS INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Additional Payment Expected2012-06-27T00:00:002012-08-14T00:00:00Property and CasualtyHomeownersHomeowners63701Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF; WATER DAMAGE136FOREMOST LLOYDS OF TEXASInsuredCancellation; Premium NoticeNoInformation Furnished2012-05-24T00:00:002012-08-01T00:00:00Property and CasualtyFire, Allied Lines & CMPXX-Dwelling Fire698Ins Co - Licensed/ActiveOrganizationINDV136FIRE INSURANCE EXCHANGEInsuredPremium NoticeNoRecord Only; Information Furnished2012-05-24T00:00:002012-08-01T00:00:00Property and CasualtyFire, Allied Lines & CMPXX-Dwelling Fire2606Ins Co - Licensed/ActiveOrganizationINDV137NEW ERA LIFE INSURANCE COMPANYOtherDelays (Policyholder Service)NoInformation Furnished; Company Position Upheld; Claim Not Clean2012-05-17T00:00:002012-07-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1513Ins Co - Licensed/ActiveOrganizationORG138AAA TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimYesClaim Settled2012-06-27T00:00:002012-08-07T00:00:00Property and CasualtyAutomobileIndividual Private Pass2286Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation139USAA CASUALTY INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferYesClaim Settled2012-06-18T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass3607Ins Co - Licensed/ActiveOrganizationINDV140UNITEDHEALTHCARE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferYesAdditional Monies Received2012-06-26T00:00:002012-08-08T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV141AVIVA LIFE AND ANNUITY COMPANYInsuredRefund Of PremiumNoInformation Furnished; Contract Language/Legal Issue2012-05-15T00:00:002012-10-01T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2959Ins Co - Licensed/ActiveOrganizationINDV141STOVER, KEN ALANInsuredMisrepresentationNoInformation Furnished; Question of Fact2012-05-15T00:00:002012-10-01T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life73648AgentIndividualINDV142UNITED SERVICES AUTOMOBILE ASSOCIATIONInsuredUnsatisfactory Settle/OfferNoQuestion of Fact2012-06-27T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1254Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation143DRIVER'S INSURANCE COMPANYInsuredDelays (Claims Handling)YesInformation Furnished; Additional Monies Received2012-06-27T00:00:002012-08-08T00:00:00Property and CasualtyAutomobileIndividual Private Pass2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DEDUCTIBLE144SOUTHERN VANGUARD INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNo2012-06-27T00:00:002012-08-20T00:00:00Property and CasualtyHomeownersHomeowners9429Ins Co - Licensed/ActiveOrganizationINDVHAIL; SENIOR CITIZEN144ABELOW, HARRY DAVIDInsuredOtherNoCompany Position Upheld2012-06-27T00:00:002012-08-20T00:00:00Property and CasualtyHomeownersHomeowners12929AgentIndividualINDVHAIL; SENIOR CITIZEN145AMERICAN GENERAL LIFE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoClaim Settled2012-06-19T00:00:002012-08-06T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured152Ins Co - Licensed/ActiveOrganizationINDV147AETNA LIFE INSURANCE COMPANYProviderDenial Of ClaimNoInformation Furnished2012-06-15T00:00:002012-12-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Self-Funded / ErisaOrganizationINDVGR-Claim Evaluation148TRAVELERS LLOYDS OF TEXAS INSURANCE COMPANYInsuredDelays (Claims Handling); Non-RenewalNoAdditional Monies Received; Complainant Retained Attorney; Cancel/Non-Renewal Upheld2012-06-26T00:00:002012-11-01T00:00:00Property and CasualtyHomeownersHomeowners776Ins Co - Licensed/ActiveOrganizationINDVACV; EXAM UNDER OATH; UNDERWRITING CRITERIA149UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-06-27T00:00:002012-07-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured1348Ins Co - Licensed/ActiveOrganizationORG150WASHINGTON NATIONAL INSURANCE COMPANYInsuredRefund Of PremiumNoPremium Refunded2012-06-21T00:00:002012-08-23T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Agent1196Ins Co - Licensed/ActiveOrganizationINDV151OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld; Contract Language/Legal Issue2012-06-27T00:00:002012-08-16T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; NAMED DRIVER POLICY152SELECTCARE OF TEXAS, L.L.C.ProviderDelays (Claims Handling)NoAdditional Monies Received; No Jurisdiction; Claim Settled2012-06-25T00:00:002012-10-18T00:00:00Health Maintenance OrgAccident and HealthIndividual A & H14275Health Maintenance OrgOrganizationORG154CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-06-27T00:00:002012-08-08T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Ins Co - Licensed/ActiveOrganizationORG155AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoCompany Position Upheld2012-06-19T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG156FIRE INSURANCE EXCHANGEInsuredCust Service Claim Handling; Delays (Claims Handling)YesClaim Settled2012-06-26T00:00:002012-08-07T00:00:00Property and CasualtyHomeownersHomeowners2606Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation157LIBERTY COUNTY MUTUAL INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling)NoAdditional Payment Expected; Information Furnished2012-06-19T00:00:002012-08-14T00:00:00Property and CasualtyAutomobileIndividual Private Pass3762Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation158HICKEY, JAMES SHERIDAN IIIAgentMisrepresentationNoCompany Position Upheld2012-06-13T00:00:002012-09-19T00:00:00Property and CasualtyLiabilityXX-GeneralAssociated Subject Company; Insured Company452382AgentIndividualINDV159GREAT AMERICAN INSURANCE COMPANY OF NEW YORKAgentDelays (Claims Handling)NoCompany Position Upheld2012-02-17T00:00:002012-09-19T00:00:00Property and CasualtyLiabilityXX-General134Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; DAMAGE DISPUTE; GR-Claim Evaluation160SELECTCARE OF TEXAS, L.L.C.ProviderDelays (Claims Handling)NoNo Jurisdiction2012-06-25T00:00:002012-09-17T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured14275Health Maintenance OrgOrganizationORGSENIOR CITIZEN162BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredClaim Recoding/BundlingNoInformation Furnished2012-06-04T00:00:002012-08-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Third Party Admin-Non Licensed10047Ins Co - Licensed/ActiveOrganizationINDV163TEXAS FARMERS INSURANCE COMPANYInsuredDelays (Claims Handling); Denial Of ClaimNoCompany Position Upheld2012-06-19T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; DAMAGE DISPUTE164LOYA INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; Company Position Upheld2012-06-07T00:00:002012-07-26T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured15643Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED165AETNA LIFE INSURANCE COMPANYRelativeDelays (Claims Handling)NoOther; No Jurisdiction2012-06-22T00:00:002013-01-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation167SELECTCARE OF TEXAS, L.L.C.Contracted ProviderDelays (Claims Handling)NoInformation Furnished; No Jurisdiction; Additional Monies Received2012-06-25T00:00:002012-10-13T00:00:00Medicare HMOAccident and HealthGroup A&HAssociated Subject Company; Correspondent Person; Insured14275Health Maintenance OrgOrganizationORG168TEXAS MUTUAL INSURANCE COMPANYNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-06-18T00:00:002012-10-19T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Company; Correspondent Person; Insured3500WC Healthcare Provider NtwkOrganizationORG169ROSALES, JESSIE ALEJANDROAgentOtherNoOther2012-06-13T00:00:002012-12-18T00:00:00Property and CasualtyMiscellaneousP & C Misc584248AgentIndividualINDV170BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONAgentUnsatisfactory Settle/OfferYesAdditional Monies Received; Claim Settled; Contract Language/Legal Issue2012-05-29T00:00:002012-09-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HDeceased Person10047Ins Co - Licensed/ActiveOrganizationINDV171PACHICANO, TRINIDADInsuredRefund Of PremiumYesReferred for Disciplinary Actn2012-05-31T00:00:002012-07-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass1127953AgentIndividualINDV173CPR-ASO, LLCInsuredDelays (Claims Handling)YesReferred for Disciplinary Actn; Opened/Linked to Case File2012-06-27T00:00:002012-08-03T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company; Correspondent Company66850Unauthorized ActivityOrganizationINDV173TRUE BENEFITSInsuredDelays (Claims Handling)YesOpened/Linked to Case File; Referred for Disciplinary Actn2012-06-27T00:00:002012-08-03T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company; Correspondent Company67456Unauthorized ActivityOrganizationINDV175AAA TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredRefund Of PremiumNoAdditional Monies Received; Contract Language/Legal Issue; Additional Payment Expected2012-05-17T00:00:002012-08-20T00:00:00Property and CasualtyAutomobileIndividual Private Pass2286Ins Co - Licensed/ActiveOrganizationINDV176REPUBLIC LLOYDSInsuredDelays (Claims Handling)NoClaim Settled2012-06-19T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners2299Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE177COLUMBIA CASUALTY COMPANYConsumer (Non-Insured)Unsatisfactory Settle/OfferNoInformation Furnished; Additional Payment Expected; Contract Language/Legal Issue2012-06-06T00:00:002012-10-11T00:00:00Life, Accident and HealthLiabilityMisc Professional Liability51718Ins Co - Surplus LinesOrganizationINDV178HUMANA INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue2012-06-21T00:00:002012-08-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation179CICA LIFE INSURANCE COMPANY OF AMERICARelativeCash ValueNoInformation Furnished2012-06-26T00:00:002012-07-27T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life3678Ins Co - Licensed/ActiveOrganizationINDV180USAA TEXAS LLOYD'S COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling)YesClaim Settled; Additional Payment Expected2012-06-08T00:00:002012-08-15T00:00:00Property and CasualtyHomeownersHomeowners14630Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; HAIL; ROOF182PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-06-18T00:00:002012-07-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation183ASI LLOYDSInsuredDelays (Policyholder Service)NoInformation Furnished2012-05-09T00:00:002012-08-13T00:00:00Property and CasualtyHomeownersHomeownersGR Elected Official14728Ins Co - Licensed/ActiveOrganizationINDV183GAITAN, LEE YOBANNYInsuredDelays (Policyholder Service)YesInformation Furnished2012-05-09T00:00:002012-08-13T00:00:00Property and CasualtyHomeownersHomeownersGR Elected Official519711AgentIndividualINDV184STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXASInsuredDelays (Claims Handling)NoClaim Settled2012-06-26T00:00:002012-08-08T00:00:00Property and CasualtyAutomobileIndividual Private Pass1506Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; HAIL186ROBERTSON, ARON SCOTTAgentXX-Othr Violatn of Ins Law/RegNoOther2012-06-22T00:00:002012-09-19T00:00:00Property and CasualtyMiscellaneousNo Line Specified836030AgentIndividualINDV188PATRIOT HEALTH FLORIDA, INC.InsuredMisleading Advertising; Unsatisfactory Settle/OfferNoOther2012-05-30T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthDiscount Health Care Program37480Ins Co - Licensed/ActiveOrganizationINDV189USAA CASUALTY INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoCompany Position Upheld2012-06-19T00:00:002012-11-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass3607Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE190ESURANCE INSURANCE COMPANYInsuredDelays (Claims Handling)NoAdditional Payment Expected; Information Furnished; Question of Fact2012-06-21T00:00:002012-07-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass1350Ins Co - Licensed/ActiveOrganizationINDV191AETNA LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction2012-06-26T00:00:002012-07-26T00:00:00Life, Accident and HealthAccident and HealthXX-State Specific245Ins Co - Licensed/ActiveOrganizationINDV192BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONRelativeDenial Of ClaimNoCompany Position Upheld2012-04-24T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation193STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Claim Settled2012-06-27T00:00:002012-08-27T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation194AMERICAN BANKERS INSURANCE COMPANY OF FLORIDAThird PartyRefund Of PremiumYesAdditional Payment Expected; Information Furnished2012-06-12T00:00:002012-08-08T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines176Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA195METROPOLITAN LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction2012-06-25T00:00:002012-08-27T00:00:00Life, Accident and HealthAccident and HealthCredit Disability13191Ins Co - Licensed/ActiveOrganizationINDV196CATLIN SPECIALTY INSURANCE COMPANYInsuredOtherNoInformation Furnished2012-06-07T00:00:002012-12-20T00:00:00Property and CasualtyFire, Allied Lines & CMPBusiness OwnersAssociated Subject Agency; Insured Company48388Ins Co - Surplus LinesOrganizationINDVCOVERAGE DISPUTE; POLICY EXCLUSION; UNDERWRITING CRITERIA196DAVIS, LESLIE LINDSEYInsuredAgent Handling; MisrepresentationYesReferred for Disciplinary Actn2012-06-07T00:00:002012-12-20T00:00:00Property and CasualtyFire, Allied Lines & CMPBusiness OwnersAssociated Subject Agency; Insured Company522545AgentIndividualINDVCOVERAGE DISPUTE; POLICY EXCLUSION; UNDERWRITING CRITERIA197FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYConsumer (Non-Insured)Premium NoticeNoCompany Position Upheld2012-05-09T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDV198HUMANA HEALTH PLAN OF TEXAS, INC.Contracted ProviderDenial Of ClaimNoRecord Only2012-03-14T00:00:002013-01-03T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Person702Health Maintenance OrgOrganizationORG199FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredRefund Of PremiumNoInformation Furnished; Company Position Upheld2012-06-19T00:00:002012-08-08T00:00:00Property and CasualtyAutomobileBusiness Automobile2623Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA199CRENTSIL, GIDEONInsuredRefund Of PremiumNoInformation Furnished2012-06-19T00:00:002012-08-08T00:00:00Property and CasualtyAutomobileBusiness Automobile180313AgentIndividualINDVUNDERWRITING CRITERIA200HOME STATE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Payment Expected; Information Furnished2012-05-14T00:00:002012-07-16T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2362Ins Co - Licensed/ActiveOrganizationINDV202DELTA DENTAL INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-06-27T00:00:002012-08-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2752Ins Co - Licensed/ActiveOrganizationORG203CIGNA HEALTHCARE OF TEXAS, INC.ProviderDelays (Claims Handling)NoNo Jurisdiction2012-06-07T00:00:002012-07-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&H8294Health Maintenance OrgOrganizationINDVGR-Claim Evaluation203GROUP & PENSION ADMINISTRATORS, INC.ProviderDelays (Claims Handling)NoNo Jurisdiction2012-06-07T00:00:002012-07-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&H32390Third Party AdministratorsOrganizationINDVGR-Claim Evaluation203Great-West HealthcareProviderDelays (Claims Handling)No2012-06-07T00:00:002012-07-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&H66384Health Maintenance OrgOrganizationINDVGR-Claim Evaluation204CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling)YesAdditional Monies Received; Stat Pen Pd-Up To 45 Dys Late; Clean Claims Violation2012-06-27T00:00:002012-08-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company2851Ins Co - Licensed/ActiveOrganizationORG205PHYSICIANS HEALTH CHOICE OF TEXAS, LLCHospitalDelays (Claims Handling)NoNo Jurisdiction2012-05-29T00:00:002012-10-22T00:00:00Medicare HMOAccident and HealthIndividual A & HInsured17170Health Maintenance OrgOrganizationORGSENIOR CITIZEN206TEXAS FARMERS INSURANCE COMPANYInsuredOtherNoInsufficient Information2012-06-21T00:00:002012-08-22T00:00:00Property and CasualtyAutomobileIndividual Private Pass1452Ins Co - Licensed/ActiveOrganizationINDV207ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoRecord Only2012-06-26T00:00:002012-11-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; CHIROPRACTIC; GR-Claim Evaluation208BRISTOL WEST SPECIALTY INSURANCE COMPANYInsuredAgent Handling; XX-Abusive ServiceNoInformation Furnished2012-07-03T00:00:002012-07-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass8129Ins Co - Licensed/ActiveOrganizationINDV208BENNETT, LORENZO D JRInsuredUnauthorized ActsYes2012-07-03T00:00:002012-07-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass345252AgentIndividualINDV212FARMERS INSURANCE EXCHANGEInsuredDenial Of ClaimNoCompany Position Upheld2012-06-21T00:00:002012-11-14T00:00:00Property and CasualtyHomeownersHomeownersInsured Company2668Ins Co - Licensed/ActiveOrganizationINDV212FARIAS, FELIPEInsuredCust Service Claim Handling; Denial Of ClaimNoQuestion of Fact2012-06-21T00:00:002012-11-14T00:00:00Property and CasualtyHomeownersHomeownersInsured Company32828AgentIndividualINDV214UNITED SERVICES AUTOMOBILE ASSOCIATIONConsumer (Non-Insured)OtherNoInformation Furnished2012-06-18T00:00:002012-07-26T00:00:00Property and CasualtyMiscellaneousNo Line Specified1254Ins Co - Licensed/ActiveOrganizationINDV215ROCKHILL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Payment Expected; Complainant Retained Attorney; Information Furnished2012-06-19T00:00:002012-08-29T00:00:00Property and CasualtyLiabilityGeneral LiabilityAssociated Subject Agency; Associated Subject Person; Insured Company55957Ins Co - Surplus LinesOrganizationINDVADJUSTER'S HANDLING216GLOBE LIFE AND ACCIDENT INSURANCE COMPANYInsuredDelays (Underwriting)NoCompany Position Upheld2012-06-27T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life917Ins Co - Licensed/ActiveOrganizationINDV217TEXAS MUTUAL INSURANCE COMPANYNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-06-21T00:00:002012-10-19T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Company; Associated Subject Person; Correspondent Person; Insured3500WC Healthcare Provider NtwkOrganizationORGGR-Claim Evaluation218TEXAS WINDSTORM INSURANCE ASSOCIATIONAgentDelays (Claims Handling); Denial Of Claim; Unsatisfactory Settle/OfferNoContract Language/Legal Issue2012-05-09T00:00:002012-08-20T00:00:00Property and CasualtyHomeownersHomeownersInsured1444TWIAOrganizationORGDAMAGE DISPUTE; POLICY EXCLUSION; ROOF; WATER DAMAGE219JONES, ERIC WADEInsuredAgent Handling; CancellationNoCancel/Non-Renewal Upheld2012-06-14T00:00:002012-09-26T00:00:00Property and CasualtyHomeownersMobile HomeownerAssociated Subject Agency; Associated Subject Company427385AgentIndividualINDV220CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-06-18T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORG221AETNA LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-06-26T00:00:002012-08-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV222BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredRefund Of PremiumNoContract Language/Legal Issue2012-05-07T00:00:002012-08-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV223ALLSTATE LIFE INSURANCE COMPANYInsuredXX-Abusive ServiceYesInformation Furnished; Policy Issued/Restored2012-07-03T00:00:002012-07-16T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities169Ins Co - Licensed/ActiveOrganizationINDV226UNITEDHEALTHCARE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-06-25T00:00:002012-07-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV227OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoQuestion of Fact2012-05-14T00:00:002012-07-26T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVAPPRAISAL; DAMAGE DISPUTE; DIMINISHED VALUE228ING LIFE INSURANCE AND ANNUITY COMPANYInsuredUnsatisfactory Settle/OfferNo2012-06-11T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H197Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation228UNITEDHEALTHCARE INSURANCE COMPANYInsuredNot Within TDI JurisdictionNoNo Jurisdiction2012-06-11T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1348Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation228ADP Cobra ServicesInsuredOtherNo2012-06-11T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H66391OtherOrganizationINDVGR-Claim Evaluation229DRIVER'S INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoAdditional Payment Expected; Information Furnished2012-06-14T00:00:002012-08-09T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; REPLACEMENT VEHICLE; TOTAL LOSS230UNITEDHEALTHCARE INSURANCE COMPANYPhysicianMedical NecessityNoInsufficient Information; Company Position Upheld; Information Furnished2012-06-18T00:00:002012-08-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGPRESCRIPTION231BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDelays In AuthorizationNoInformation Furnished2012-06-27T00:00:002012-08-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV232TEXAS STAR NETWORK/COVENTRYHospitalDenial Of ClaimNoInformation Furnished; Record Only2012-01-10T00:00:002012-10-18T00:00:00Workers Compensation NetworkAccident and HealthGroup A&HAlias Name; Associated Subject Company; Correspondent Person55311WC Healthcare Provider NtwkOrganizationORG233DRIVER'S INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue2012-05-10T00:00:002012-10-01T00:00:00Property and CasualtyAutomobileIndividual Private Pass2038Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE233ALVAREZ, NICHOLAS JInsuredAgent HandlingYesOther; Failure to Timely Respond2012-05-10T00:00:002012-10-01T00:00:00Property and CasualtyAutomobileIndividual Private Pass778299AgentIndividualINDVCOVERAGE DISPUTE234ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Additional Monies Received; Claim Settled2012-06-27T00:00:002012-08-14T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured9825Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED235TIME INSURANCE COMPANYContracted ProviderUnsatisfactory Settle/OfferYesInformation Furnished; Corrective Action Taken2012-05-29T00:00:002012-07-24T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1374Ins Co - Licensed/ActiveOrganizationORG236CONSUMERS COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld; Additional Payment Expected2012-05-31T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass2806Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation237PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-06-19T00:00:002012-08-20T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVACV; DAMAGE DISPUTE; GR-Claim Evaluation238BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONThird PartyDelays (Claims Handling)NoCompany Position Upheld2012-06-26T00:00:002012-08-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG239STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredDelays (Claims Handling)NoCompany Position Upheld2012-06-07T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners1510Ins Co - Licensed/ActiveOrganizationINDV240SOUTHERN COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished; Question of Fact2012-06-18T00:00:002012-07-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass1583Ins Co - Licensed/ActiveOrganizationINDV241DVORAK, KIRK WILLIAMInsurance CompanyAgency BalanceNoOther2012-06-21T00:00:002012-08-21T00:00:00Property and CasualtyMiscellaneousNo Line Specified1095111AgentIndividualORG242TEXAS FARMERS INSURANCE COMPANYAttorneyCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue; Additional Monies Received2012-05-09T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BETTERMENT; DAMAGE DISPUTE; GR-Claim Evaluation; WATER DAMAGE243BRUMLEY-RITTER, KIMBERLY GAILOtherAgent HandlingNoCompany Position Upheld2012-06-14T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Insured88270AgentIndividualORG244INDEPENDENT ORDER OF FORESTERS, THEOtherDelays (Claims Handling)NoInformation Furnished; Claim Settled2012-06-27T00:00:002012-10-23T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured13242Ins Co - Licensed/ActiveOrganizationORG245LOYA INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Company Position Upheld2012-06-27T00:00:002012-08-14T00:00:00Property and CasualtyAutomobileIndividual Private Pass15643Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; LOSS OF USE246VISION INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld; Additional Payment Expected; Information Furnished2012-06-12T00:00:002012-08-14T00:00:00Property and CasualtyAutomobileIndividual Private Pass23478Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation247CONSUMERS COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Policyholder Service)YesCorrective Action Taken2012-05-22T00:00:002012-09-05T00:00:00Property and CasualtyAutomobileIndividual Private Pass2806Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE248BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-06-27T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation249RELIABLE LLOYDS INSURANCE COMPANYInsuredDelays (Claims Handling)NoAdditional Monies Received2012-05-07T00:00:002012-07-26T00:00:00Property and CasualtyHomeownersHomeowners3430Ins Co - Licensed/ActiveOrganizationINDV251CONNECTICUT GENERAL LIFE INSURANCE COMPANYPhysicianUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-06-18T00:00:002012-08-28T00:00:00Employee Retirement SystemAccident and HealthGroup A&HAssociated Subject Company; Correspondent Person; Insured2851Ins Co - Licensed/ActiveOrganizationORG252STONEBRIDGE LIFE INSURANCE COMPANYInsuredRefund Of PremiumNoCancel/Non-Renewal Upheld2012-05-11T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2269Ins Co - Licensed/ActiveOrganizationINDV253ACE AMERICAN INSURANCE COMPANYInsuredDelays (Claims Handling)NoQuestion of Fact2012-05-31T00:00:002012-08-02T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company2327Ins Co - Licensed/ActiveOrganizationINDV254ATLANTIC CASUALTY INSURANCE COMPANYAttorneyDelays (Claims Handling)NoRecord Only2012-06-19T00:00:002012-11-08T00:00:00Property and CasualtyHomeownersCondominium52002Ins Co - Surplus LinesOrganizationINDV255FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredLiability DisputeNoCompany Position Upheld; Information Furnished2012-06-19T00:00:002012-07-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDV256GEICO INDEMNITY COMPANYThird PartyUnsatisfactory Settle/OfferNoClaim Settled; Information Furnished; Additional Monies Received2012-06-18T00:00:002012-07-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass2785Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; DAMAGE DISPUTE; LOSS OF USE257CORNERSTONE GENERAL CONTRACTINGGR Other Government OfficeUnauthorized ActsYesOther2012-06-25T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners66403Unauthorized ActivityOrganizationORG258MARTINEZ, ISMAEL ARONAgentCommissionsNoNo Jurisdiction2012-06-27T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass261497AgentIndividualINDV259OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoClaim Settled; Information Furnished2012-06-14T00:00:002012-08-14T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured; Third Party Admin-Licensed1823Ins Co - Licensed/ActiveOrganizationINDVLOSS OF USE260BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONRelativeBalance BillingNoInformation Furnished; Contract Language/Legal Issue2012-06-22T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation; MEDICAL SAVINGS ACCOUNT261TEXAS DENTAL PLANS, INC.InsuredRefund Of PremiumYesPremium Refunded2012-06-27T00:00:002012-08-17T00:00:00Health Maintenance OrgAccident and HealthGroup A&H37645Ins Co - Licensed/ActiveOrganizationINDV263STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished2012-06-19T00:00:002012-11-27T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDV264CONNECTICUT GENERAL LIFE INSURANCE COMPANYNon-Contracted ProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-06-18T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured2851Self-Funded / ErisaOrganizationORG265AMERICAN FAMILY LIFE ASSURANCE COMPANY OF COLUMBUSInsuredDelays (Claims Handling)NoClaim Settled; Contract Language/Legal Issue2012-04-17T00:00:002012-07-18T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2655Ins Co - Licensed/ReceivershipOrganizationINDV266INFINITY COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)YesClaim Settled; Information Furnished; Additional Monies Received2012-06-27T00:00:002012-08-23T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1197Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; UNCOOPERATIVE INSURED267BANNER LIFE INSURANCE COMPANYRelativeDelays (Claims Handling)NoReferred for Disciplinary Actn; Contract Language/Legal Issue2012-05-14T00:00:002012-08-06T00:00:00Life, Accident and HealthLife & AnnuityCredit Life657Ins Co - Licensed/ActiveOrganizationINDV268MGA INSURANCE COMPANY, INC.InsuredDenial Of Claim; Unsatisfactory Settle/OfferNoAdditional Payment Expected; Company Position Upheld2012-06-05T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass812Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation; REPLACEMENT VEHICLE269TEXAS FARMERS INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-06-18T00:00:002012-08-09T00:00:00Property and CasualtyAutomobileIndividual Private Pass1452Ins Co - Licensed/ActiveOrganizationINDVAFTERMARKET PARTS271GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyDenial Of ClaimNoQuestion of Fact2012-06-12T00:00:002012-07-23T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation272UNITEDHEALTHCARE INSURANCE COMPANYGR Other Government OfficeMisrepresentationNoNo Jurisdiction2012-05-16T00:00:002012-08-20T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1348Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN272KELLY, DAVID ERICGR Other Government OfficeMisrepresentationNoQuestion of Fact2012-05-16T00:00:002012-08-20T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H205227AgentIndividualORGSENIOR CITIZEN273Brahma TitleConsumer (Non-Insured)Refund Of PremiumNoAdditional Payment Expected2012-06-14T00:00:002012-09-19T00:00:00Property and CasualtyMiscellaneousNo Line Specified66405AgentOrganizationINDV274FIRE INSURANCE EXCHANGEInsuredDelays (Claims Handling)NoCompany Position Upheld2012-06-15T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeownersGR Elected Official2606Ins Co - Licensed/ActiveOrganizationINDV275PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredPremium NoticeNoCompany Position Upheld2012-06-07T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDV276PHYSICIANS HEALTH CHOICE OF TEXAS, LLCHospitalMedical Necessity; XX-Appeal Non-ComplianceNoInformation Furnished; No Jurisdiction2012-05-29T00:00:002012-09-05T00:00:00Medicare HMOAccident and HealthGroup A&HCorrespondent Person; Insured17170Health Maintenance OrgOrganizationORGSENIOR CITIZEN277STATE FARM LLOYDSInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferYesAdditional Monies Received; Information Furnished2012-06-25T00:00:002012-09-06T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; COVERAGE DISPUTE; DAMAGE DISPUTE; GR-Claim Evaluation; SUPPLEMENTARY PAYMENT; WATER DAMAGE278METROPOLITAN LIFE INSURANCE COMPANYBeneficiaryDelays (Claims Handling)NoNo Jurisdiction2012-06-21T00:00:002012-07-11T00:00:00Life, Accident and HealthLife & AnnuityGroup LifeInsured13191Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation279HDI SEGUROS, S.A. DE C.V.InsuredNon-Disclosure Of Coverage; Unsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received; Contract Language/Legal Issue2012-06-05T00:00:002012-08-23T00:00:00Property and CasualtyMiscellaneousP & C MiscThird Party Admin-Non Licensed3755Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation280WESTERN HERITAGE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld2012-06-11T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass51924Ins Co - Surplus LinesOrganizationINDV281HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished2012-06-27T00:00:002012-08-13T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent2362Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING282NATIONAL WESTERN LIFE INSURANCE COMPANYConsumer (Non-Insured)OtherNoCompany Position Upheld; No Jurisdiction2012-05-21T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities1933Ins Co - Licensed/ActiveOrganizationINDV283CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling); Denial Of ClaimNoRecord Only2012-06-20T00:00:002012-12-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Ins Co - Licensed/ActiveOrganizationORG284LOYA INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoClaim Settled; Information Furnished2012-06-07T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass15643Ins Co - Licensed/ActiveOrganizationINDV285ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYConsumer (Non-Insured)Agent HandlingYesInformation Furnished2012-06-14T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners936Ins Co - Licensed/ActiveOrganizationINDVADVERTISING; CREDIT REPORT286LIBERTY HEALTH CARE NETWORKPhysicianDenial Of ClaimYesInformation Furnished2012-03-29T00:00:002012-12-05T00:00:00Workers Compensation NetworkAccident and HealthGroup A&HAssociated Subject Company54531WC Healthcare Provider NtwkOrganizationINDV288PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and RatingNoCompany Position Upheld2012-06-12T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation289CAROLINA CASUALTY INSURANCE COMPANYInsuredDelays (Claims Handling); Denial Of ClaimNoCompany Position Upheld2012-06-04T00:00:002012-10-09T00:00:00Property and CasualtyFire, Allied Lines & CMPBusiness Owners2937Ins Co - Licensed/ActiveOrganizationINDV289SPECIALTY INSURANCE MANAGERS INCInsuredAgent HandlingNoCompany Position Upheld2012-06-04T00:00:002012-10-09T00:00:00Property and CasualtyFire, Allied Lines & CMPBusiness Owners5795Insurance AgencyOrganizationINDV290HUMANA INSURANCE COMPANYInsuredDelays (Policyholder Service)NoNo Jurisdiction2012-06-08T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationINDV291CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesNo Jurisdiction; Additional Monies Received2012-06-18T00:00:002012-10-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Self-Funded / ErisaOrganizationORG292SOUTHERN COUNTY MUTUAL INSURANCE COMPANYInsuredCancellation; Liability DisputeNoInformation Furnished; Company Position Upheld2012-06-26T00:00:002012-12-28T00:00:00Property and CasualtyAutomobileTruckers Policy1583Ins Co - Licensed/ActiveOrganizationINDV293PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; Additional Payment Expected2012-06-07T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDV294ALLSTATE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled2012-06-19T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileIndividual Private Pass168Ins Co - Licensed/ActiveOrganizationINDVREPLACEMENT VEHICLE; TOTAL LOSS294ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling)No2012-06-19T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDVREPLACEMENT VEHICLE; TOTAL LOSS295STATE FARM LLOYDSInsuredPremium and RatingNoInformation Furnished2012-06-18T00:00:002012-07-30T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE296COMMONWEALTH ANNUITY AND LIFE INSURANCE COMPANYInsuredCash ValueNoInformation Furnished; Contract Language/Legal Issue2012-05-31T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life3627Ins Co - Licensed/ActiveOrganizationINDV296LYNCH, PATRICK JOSEPH IIIInsuredMisrepresentationNoContract Language/Legal Issue; Question of Fact2012-05-31T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life47812AgentIndividualINDV297U S LLOYDS INSURANCE COMPANYInsuredDelays (Claims Handling); DisasterNoClaim Settled2012-05-14T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners3177Ins Co - Licensed/ActiveOrganizationINDV2012 NORTH TEXAS TORNADOES298CATHOLIC LIFE INSURANCEInsuredMisrepresentationNoContract Language/Legal Issue; Information Furnished2012-06-21T00:00:002012-07-26T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities2946Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation299National Condo & Apartment Insurance GroupInsuredXX-Payment Not CreditedYes2012-05-24T00:00:002012-08-02T00:00:00Property and CasualtyHomeownersCondominium66502AgentOrganizationINDV299WOEDL, SHAWN EUGENEInsuredDelays (Policyholder Service); XX-Abusive Service; XX-Payment Not CreditedYesReferred for Disciplinary Actn; Failure to Timely Respond2012-05-24T00:00:002012-08-02T00:00:00Property and CasualtyHomeownersCondominium1113412AgentIndividualINDV300TEXAS COMMUNITY CAREHospitalDelays (Claims Handling)NoInformation Furnished2012-05-29T00:00:002012-08-27T00:00:00Health Maintenance OrgAccident and HealthIndividual A & H66412Health Maintenance OrgOrganizationORG301HALLMARK COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoFailure to Timely Respond2012-06-14T00:00:002012-08-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass1505Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING302Buffett Senior HealthcareAgentOtherNoInsufficient Information2012-06-27T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H67575OtherOrganizationINDV303USAA CASUALTY INSURANCE COMPANYThird PartyDenial Of ClaimNoAdditional Payment Expected; Information Furnished2012-06-08T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass3607Ins Co - Licensed/ActiveOrganizationINDV304STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDenial Of ClaimYesQuestion of Fact; Additional Payment Expected2011-06-15T00:00:002012-07-25T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation304PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyOtherNoContract Language/Legal Issue2011-06-15T00:00:002012-07-25T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1708Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation305ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-06-13T00:00:002012-07-26T00:00:00Property and CasualtyHomeownersHomeowners936Ins Co - Licensed/ActiveOrganizationINDVHAIL; ROOF307NATIONWIDE PROPERTY AND CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Additional Payment Expected2012-06-13T00:00:002012-08-30T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured Company3165Ins Co - Licensed/ActiveOrganizationINDV308TIME INSURANCE COMPANYInsuredDenial Of ClaimYesPolicy Issued/Restored; Information Furnished; Additional Monies Received2012-07-03T00:00:002012-10-16T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1374Ins Co - Licensed/ActiveOrganizationINDVRESCISSION309BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONOtherDelays (Claims Handling)YesStat Pen Pd-Over 90 Dys Late; Clean Claims Violation2012-04-27T00:00:002012-07-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationORG310GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished2012-06-13T00:00:002012-07-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVREPLACEMENT VEHICLE311LINCOLN NATIONAL LIFE INSURANCE COMPANY, THERelativeDelays (Claims Handling)NoPolicy Not In Force2012-05-23T00:00:002012-07-19T00:00:00Life, Accident and HealthLife & AnnuityGroup AnnuitiesInsured2172Ins Co - Licensed/ActiveOrganizationINDV312UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-05-21T00:00:002012-07-23T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1348Ins Co - Licensed/ActiveOrganizationINDV313OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYAttorneyDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Question of Fact2012-06-14T00:00:002012-09-24T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING314SAFE AUTO INSURANCE COMPANYThird PartyDelays (Claims Handling)YesReimburse; Claim Settled2012-06-11T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured25980Ins Co - Licensed/ActiveOrganizationINDV316AETNA LIFE INSURANCE COMPANYInsuredDenial Of ClaimYesInformation Furnished2012-06-27T00:00:002012-08-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV317AMERICAN GENERAL LIFE INSURANCE COMPANYBeneficiaryCust Service Claim HandlingNo2012-05-31T00:00:002012-10-10T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured152Ins Co - Licensed/ActiveOrganizationINDV317FRANKLIN LIFE INSURANCE COMPANY, THEBeneficiaryCust Service Claim HandlingNoInsufficient Information2012-05-31T00:00:002012-10-10T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured2542Ins Co - Licensed/ReceivershipOrganizationINDV317UNIFIED LIFE INSURANCE COMPANYBeneficiaryDelays (Policyholder Service)No2012-05-31T00:00:002012-10-10T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured14633Ins Co - Licensed/ActiveOrganizationINDV318PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld2012-06-13T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileXX-Commercial1708Ins Co - Licensed/ActiveOrganizationINDVAPPRAISAL; DEPRECIATION; DIMINISHED VALUE; GR-Claim Evaluation; TOTAL LOSS; UNCOOPERATIVE INSURED319AETNA HEALTH INC.ProviderDelays (Claims Handling); Denial Of ClaimNoCompany Position Upheld2012-06-20T00:00:002012-09-19T00:00:00Health Maintenance OrgAccident and HealthGroup A&H3522Ins Co - Licensed/ActiveOrganizationINDV320NATIONWIDE PROPERTY AND CASUALTY INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished2012-06-13T00:00:002012-07-27T00:00:00Property and CasualtyHomeownersHomeowners3165Ins Co - Licensed/ActiveOrganizationINDV321AMERICAN NATIONAL INSURANCE COMPANYRelativeCash Value; Delays (Policyholder Service)NoCash Surrender Paid2012-06-27T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured135Ins Co - Licensed/ActiveOrganizationINDV322PRUDENTIAL INSURANCE COMPANY OF AMERICA, THEInsuredPremium NoticeNoRate Problem Resolved2012-05-29T00:00:002012-08-06T00:00:00Life, Accident and HealthLife & AnnuityGroup Life1729Ins Co - Licensed/ActiveOrganizationINDV323WILTON REASSURANCE LIFE COMPANY OF NEW YORKInsuredDelays (Policyholder Service)NoCorrective Action Taken; Information Furnished2012-05-23T00:00:002012-08-20T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesAssociated Subject Company121Ins Co - Licensed/ReceivershipOrganizationINDVSENIOR CITIZEN324DAIRYLAND COUNTY MUTUAL INSURANCE COMPANY OF TEXASLienholderDelays (Claims Handling); Denial Of ClaimNoInformation Furnished2012-06-13T00:00:002012-07-16T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2737Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; UNCOOPERATIVE INSURED324GARZA, DANIELLienholderAgent HandlingNoInformation Furnished2012-06-13T00:00:002012-07-16T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured559527AgentIndividualORGADJUSTER'S HANDLING; UNCOOPERATIVE INSURED325CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-06-25T00:00:002012-07-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Ins Co - Licensed/ActiveOrganizationINDV326OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYAgentUnsatisfactory Settle/OfferNoInformation Furnished2012-06-26T00:00:002012-07-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED327UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesInformation Furnished; Additional Monies Received2012-05-31T00:00:002012-08-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationORG328TIME INSURANCE COMPANYInsuredPremium NoticeNoRate Problem Resolved2012-05-29T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1374Ins Co - Licensed/ActiveOrganizationINDV329MCCALL, HIBLER & ALLEN, INC.InsuredDelays (Policyholder Service)NoInformation Furnished2012-06-25T00:00:002012-09-26T00:00:00Property and CasualtyHomeownersHomeowners4422Insurance AgencyOrganizationINDV330PHILADELPHIA INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Additional Payment Expected2012-06-04T00:00:002012-08-02T00:00:00Property and CasualtyAutomobileBusiness Automobile56200Ins Co - Surplus LinesOrganizationINDVADJUSTER'S HANDLING331BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONOtherPrompt Pay; SB418 Rule ViolationYesClean Claims Violation; Additional Monies Received2012-05-31T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG332TEXAS FARMERS INSURANCE COMPANYInsuredCancellationNoInformation Furnished; Company Position Upheld; Policy Issued/Restored2012-06-26T00:00:002012-08-16T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDV332KIMBROUGH, DAVID KInsuredAgent HandlingNoInformation Furnished; Company Position Upheld2012-06-26T00:00:002012-08-16T00:00:00Property and CasualtyHomeownersHomeowners150295AgentIndividualINDV333HOME DEPOTOtherMisleading Advertising; MisrepresentationNoInsufficient Information2012-06-26T00:00:002012-12-05T00:00:00Property and CasualtyHomeownersHomeowners66420Unauthorized ActivityOrganizationINDV334TIME INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferYesInformation Furnished2012-06-20T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1374Ins Co - Licensed/ActiveOrganizationINDV335AETNA HEALTH INSURANCE COMPANYProviderDenial Of ClaimNoClaim Settled2012-05-31T00:00:002012-07-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1839Ins Co - Licensed/ActiveOrganizationORG336TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished; Company Position Upheld2012-06-11T00:00:002012-07-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass1450Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA337ASAP SECURITY SERVICESConsumer (Non-Insured)Misleading AdvertisingNoRecord Only2012-06-25T00:00:002012-09-19T00:00:00Property and CasualtyMiscellaneousNo Line Specified39033OtherOrganizationINDV338SELECT BENEFITS GROUP, INC.PhysicianDelays (Claims Handling)NoCompany Position Upheld2012-05-23T00:00:002012-09-17T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company; Insured18581Third Party AdministratorsOrganizationINDV339SAFECO INSURANCE COMPANY OF AMERICAInsuredDenial Of ClaimNoCompany Position Upheld2012-06-11T00:00:002012-10-10T00:00:00Property and CasualtyHomeownersHomeowners1619Ins Co - Licensed/ActiveOrganizationINDV340SANTA FE AUTO INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-06-28T00:00:002012-08-13T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured27766Ins Co - Licensed/ActiveOrganizationINDV341TEXAS INSURANCE SERVICE CENTER INC.Consumer (Non-Insured)OtherNoQuestion of Fact2012-06-14T00:00:002012-07-24T00:00:00Property and CasualtyFire, Allied Lines & CMPXX-Builder's Risk30412Insurance AgencyOrganizationINDV342STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredDelays (Policyholder Service)NoCompany Position Upheld2012-05-26T00:00:002012-08-25T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV342JASMINOY, JAVIER MARCELOInsuredXX-Abusive ServiceYesInformation Furnished2012-05-26T00:00:002012-08-25T00:00:00Property and CasualtyAutomobileIndividual Private Pass546373AgentIndividualINDV343CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction; Additional Monies Received2012-06-26T00:00:002012-07-24T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured25422Ins Co - Licensed/ActiveOrganizationORG344BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONOtherPrompt Pay; SB418 Rule ViolationYesClean Claims Violation; Additional Monies Received; Stat Pen Pd-46 To 90 Dys Late2012-05-31T00:00:002012-08-07T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured10047Ins Co - Licensed/ActiveOrganizationORG345HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-06-04T00:00:002012-08-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency2362Ins Co - Licensed/ActiveOrganizationINDV345TOMBERLAIN, CHARLES MORGANInsuredAgent HandlingNoInformation Furnished2012-06-04T00:00:002012-08-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency111608AgentIndividualINDV346GROUP & PENSION ADMINISTRATORS, INC.PhysicianDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-06-20T00:00:002012-09-19T00:00:00Employee Retirement SystemAccident and HealthGroup A&HCorrespondent Company32390Third Party AdministratorsOrganizationINDV347COLONIAL COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received; Claim Settled; Information Furnished2012-06-14T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured2455Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED348FIRE INSURANCE EXCHANGEInsuredDelays (Claims Handling)NoCompany Position Upheld2012-06-12T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners2606Ins Co - Licensed/ActiveOrganizationINDV349PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredCancellationNoCompany Position Upheld; Information Furnished2012-06-26T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDV350COMPANION LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoContract Language/Legal Issue2012-06-01T00:00:002012-12-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&HThird Party Admin-Licensed3710Ins Co - Licensed/ActiveOrganizationORG351LINCOLN NATIONAL LIFE INSURANCE COMPANY, THEBeneficiaryUnsatisfactory Settle/OfferNoInformation Furnished2012-05-01T00:00:002012-08-28T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesInsured2172Ins Co - Licensed/ActiveOrganizationINDV352CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANYProviderDelays (Claims Handling); Unsatisfactory Settle/OfferNoNo Jurisdiction2012-06-26T00:00:002012-07-31T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured25422Ins Co - Licensed/ActiveOrganizationORG353CHICAGO TITLE INSURANCE COMPANYAttorneyDelays (Claims Handling); Denial Of ClaimNoCompany Position Upheld2012-06-27T00:00:002012-09-19T00:00:00Property and CasualtyMiscellaneousTitle Insurance51988Ins Co - Licensed/ActiveOrganizationINDV354INFINITY COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoAdditional Monies Received; Claim Settled; Information Furnished2012-06-13T00:00:002012-07-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass1197Ins Co - Licensed/ActiveOrganizationINDV355CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-06-18T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORG356HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredCancellation; Denial Of ClaimNoCancel/Non-Renewal Upheld; Information Furnished2012-06-01T00:00:002012-07-31T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company2362Ins Co - Licensed/ActiveOrganizationINDV357OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld2012-06-12T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1823Ins Co - Licensed/ActiveOrganizationINDV358SECURITY LIFE OF DENVER INSURANCE COMPANYInsuredPremium NoticeNoCancel/Non-Renewal Upheld2012-05-31T00:00:002012-07-23T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1593Ins Co - Licensed/ReceivershipOrganizationINDV360HUMANA INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferYesAdditional Monies Received2012-06-20T00:00:002012-08-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationINDV361SAFECO INSURANCE COMPANY OF AMERICAInsuredDelays (Claims Handling)NoCompany Position Upheld2012-06-12T00:00:002012-09-04T00:00:00Property and CasualtyHomeownersHomeowners1619Ins Co - Licensed/ActiveOrganizationINDV362SANTA FE AUTO INSURANCE COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld2012-06-12T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass27766Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE363REASSURE AMERICA LIFE INSURANCE COMPANYRelativeDelays (Claims Handling)NoInformation Furnished2012-05-07T00:00:002012-07-18T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesInsured1228Ins Co - Licensed/ActiveOrganizationINDV364TEXAS FAIR PLAN ASSOCIATIONInsuredAgent HandlingNoOther2012-06-07T00:00:002012-08-21T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent18208Texas Fair Insurance PlanOrganizationINDV364A-1 AMERICAN INSURANCE SERVICES INCInsuredAgent HandlingNo2012-06-07T00:00:002012-08-21T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent21587AgentOrganizationINDV364BAEZA, DORAInsuredAgent HandlingNo2012-06-07T00:00:002012-08-21T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent689765AgentIndividualINDV365NATIONWIDE MUTUAL FIRE INSURANCE COMPANYInsuredXX-Coverage QuestionNoQuestion of Fact; Information Furnished2012-05-02T00:00:002012-08-21T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines1936Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE365HARBOR, HAL LInsuredDelays (Policyholder Service); XX-Coverage QuestionNoInformation Furnished; Question of Fact2012-05-02T00:00:002012-08-21T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines113731AgentIndividualINDVDEDUCTIBLE366COLONIAL LLOYDSInsuredDenial Of ClaimNoInformation Furnished2012-06-27T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners768Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; DAMAGE DISPUTE367CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANYProviderDelays (Claims Handling); Unsatisfactory Settle/OfferNoNo Jurisdiction2012-06-19T00:00:002012-09-10T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured25422Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN368AETNA LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction2012-06-20T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV369AETNA LIFE INSURANCE COMPANYProviderRecoupment Of Claims PaymentNoNo Jurisdiction2012-06-22T00:00:002012-07-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation370STATE FARM LLOYDSInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Claim Settled2012-06-05T00:00:002012-10-22T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDV371CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDenial Of ClaimNoInformation Furnished; No Jurisdiction2012-06-18T00:00:002012-11-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Self-Funded / ErisaOrganizationORG372STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXASThird PartyDenial Of ClaimNoQuestion of Fact; Information Furnished2012-06-18T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass1506Ins Co - Licensed/ActiveOrganizationINDV373ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferYesInformation Furnished; Additional Monies Received2012-06-26T00:00:002012-08-16T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured9825Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; CHIROPRACTIC; GR-Claim Evaluation374JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.)InsuredPremium and RatingNoRate Problem Resolved2012-06-27T00:00:002012-08-08T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1148Ins Co - Licensed/ActiveOrganizationINDV375STATE FARM LLOYDSRelativeUnsatisfactory Settle/OfferYesQuestion of Fact2012-06-26T00:00:002012-07-31T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent3105Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; HAIL; OVERHEAD AND PROFIT; ROOF; WATER DAMAGE377WASHINGTON NATIONAL INSURANCE COMPANYInsuredMisrepresentationNoInformation Furnished2012-06-20T00:00:002012-08-09T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1196Ins Co - Licensed/ActiveOrganizationINDV377ZAMORA, JESUSInsuredMisrepresentationNoInformation Furnished2012-06-20T00:00:002012-08-09T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H245898AgentIndividualINDV377PERKINS, TODD LORANInsuredMisrepresentationNoInformation Furnished2012-06-20T00:00:002012-08-09T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H842899AgentIndividualINDV378AMERICAN CONTINENTAL INSURANCE COMPANYInsuredCancellation; Denial Of ClaimNoInformation Furnished; Policy Not In Force2012-06-04T00:00:002012-07-17T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H27913Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN379ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredPremium and RatingYesAdditional Monies Received; Information Furnished2012-06-04T00:00:002012-08-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA380PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld2011-10-03T00:00:002012-07-12T00:00:00Property and CasualtyFire, Allied Lines & CMPBusiness OwnersAssociated Agent1708Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation; POLICY EXCLUSION381GRAMERCY INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-06-13T00:00:002012-08-31T00:00:00Property and CasualtyAutomobileIndividual Private PassThird Party Admin-Non Licensed1062Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; LOSS OF USE382ACCC INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferYesInformation Furnished; Additional Payment Expected2012-06-14T00:00:002012-08-09T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDVACV; GR-Claim Evaluation; TOTAL LOSS383BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction2012-06-27T00:00:002012-07-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV384DAIRYLAND COUNTY MUTUAL INSURANCE COMPANY OF TEXASThird PartyDelays (Claims Handling)NoQuestion of Fact; Additional Payment Expected2012-06-18T00:00:002012-07-24T00:00:00Property and CasualtyAutomobileIndividual Private PassGR Elected Official2737Ins Co - Licensed/ActiveOrganizationINDV385IMS MARKETING, INC.ProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-05-07T00:00:002012-07-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured6231Third Party AdministratorsOrganizationORG386MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANYAttorneyOtherYesAdditional Payment Expected; Information Furnished2012-05-31T00:00:002012-07-24T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured2115Ins Co - Licensed/ActiveOrganizationINDV387OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished2012-06-12T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation388PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)YesAdditional Monies Received; Information Furnished2012-06-05T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1708Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation388HOME STATE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Additional Monies Received2012-06-05T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency2362Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation389CONTINENTAL AMERICAN INSURANCE COMPANYInsuredDelays (Claims Handling)NoContract Language/Legal Issue; Additional Monies Received2012-06-04T00:00:002012-07-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&H3367Ins Co - Licensed/ActiveOrganizationINDV390UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimYesInformation Furnished2012-06-20T00:00:002012-09-18T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured1348Health Maintenance OrgOrganizationINDV391HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished; Additional Payment Expected; Complainant Retained Attorney2012-06-27T00:00:002012-08-16T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2362Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING392ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished2012-06-13T00:00:002012-07-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDV392MIGLIACCIO, VINCENTInsuredAgent Handling; XX-Premiums MisquotedYesInsufficient Information2012-06-13T00:00:002012-07-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass206039AgentIndividualINDV393UNITEDHEALTHCARE INSURANCE COMPANYContracted ProviderUnsatisfactory Settle/OfferYesClean Claims Violation; Additional Monies Received; Stat Pen Pd-Over 90 Dys Late2012-04-03T00:00:002012-08-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG394TEXAS FARMERS INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Company Position Upheld; Contract Language/Legal Issue2012-06-26T00:00:002012-08-23T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person1452Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation; POLICY EXCLUSION; WATER DAMAGE395ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled2012-06-27T00:00:002012-07-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING396TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICAThird PartyDenial Of ClaimNoCompany Position Upheld; Information Furnished2012-06-15T00:00:002012-08-16T00:00:00Property and CasualtyMiscellaneousInland MarineAssociated Subject Agency; Associated Subject Company; Insured Company1345Ins Co - Licensed/ActiveOrganizationINDV396CONTINENTAL CASUALTY COMPANYThird PartyDenial Of ClaimNoCancel/Non-Renewal Upheld; Information Furnished2012-06-15T00:00:002012-08-16T00:00:00Property and CasualtyMiscellaneousInland MarineAssociated Subject Agency; Associated Subject Company; Insured Company2814Ins Co - Licensed/ActiveOrganizationINDV397HUMANA INSURANCE COMPANYInsuredPremium NoticeNoRate Problem Resolved2012-06-01T00:00:002012-07-24T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1040Ins Co - Licensed/ActiveOrganizationINDVFEDERAL HEALTH CARE REFORM398AMACORE GROUPRelativeDelays (Policyholder Service)YesFailure to Timely Respond2012-06-18T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&H66431OtherOrganizationINDV398LANE, CURTIS KEVINRelativeDelays (Policyholder Service)YesFailure to Timely Respond2012-06-18T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&H755383AgentIndividualINDV399STATE FARM LLOYDSInsuredDenial Of ClaimNoAdditional Monies Received; Information Furnished2012-06-13T00:00:002012-07-30T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVHAIL; ROOF400OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDelays (Claims Handling); Denial Of ClaimNoRecord Only2012-06-26T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDV401OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoClaim Settled2012-06-26T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDV402CIGNA HEALTH AND LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-06-27T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1841Ins Co - Licensed/ActiveOrganizationINDV402CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNo2012-06-27T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationINDV403REPUBLIC LLOYDSThird PartyUnsatisfactory Settle/OfferNoAdditional Payment Expected2012-06-06T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners2299Ins Co - Licensed/ActiveOrganizationINDV404BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoContract Language/Legal Issue2012-06-04T00:00:002012-07-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HGR Elected Official10047Ins Co - Licensed/ActiveOrganizationINDV405BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling); Denial Of ClaimYesAdditional Monies Received2012-06-20T00:00:002012-08-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV406ALLSTATE COUNTY MUTUAL INSURANCE COMPANYInsuredCancellation; Delays (Policyholder Service)NoPolicy Issued/Restored; Information Furnished2012-06-13T00:00:002012-07-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass2228Ins Co - Licensed/ActiveOrganizationINDV407HALLMARK INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished2012-06-18T00:00:002012-07-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass24193Ins Co - Licensed/ActiveOrganizationINDV408AAA TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredRefund Of PremiumNoPremium Refunded2012-06-12T00:00:002012-07-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass2286Ins Co - Licensed/ActiveOrganizationINDV409FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredCust Service Claim Handling; Liability DisputeNoInformation Furnished2012-06-14T00:00:002012-07-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE; HAIL411PHILADELPHIA AMERICAN LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction2012-06-18T00:00:002012-07-23T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1777Ins Co - Licensed/ActiveOrganizationINDV412OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished; Company Position Upheld2012-06-27T00:00:002012-08-27T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1823Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation412FIRST ACCEPTANCE INSURANCE COMPANY, INC.Third PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld; Question of Fact; Additional Monies Received2012-06-27T00:00:002012-08-27T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured20825Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation413BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoAdditional Monies Received; Claim Settled2012-06-20T00:00:002012-08-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationORG414LOYA INSURANCE COMPANYThird PartyDenial Of Claim; Unsatisfactory Settle/OfferNoInformation Furnished; Additional Payment Expected2012-06-27T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured15643Ins Co - Licensed/ActiveOrganizationINDVTOTAL LOSS415STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXASInsuredDelays (Claims Handling)NoClaim Settled; Additional Monies Received; Information Furnished2012-06-13T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass1506Ins Co - Licensed/ActiveOrganizationINDV418AMERIGROUP TEXAS, INC.ProviderDelays (Claims Handling); Delays (Policyholder Service); Denial Of ClaimNoNo Jurisdiction2012-06-01T00:00:002012-08-01T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured8032Ins Co - Licensed/ActiveOrganizationORG419BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONAttorneyDenial Of Claim; Unsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-01-26T00:00:002012-08-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV420TEXAS MUTUAL INSURANCE COMPANYNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-06-25T00:00:002012-10-19T00:00:00Workers' CompensationMiscellaneousWorkers' CompensationAssociated Subject Agency; Correspondent Person; Insured66439Ins Co - Licensed/ActiveOrganizationORG421USAA GENERAL INDEMNITY COMPANYLienholderCust Service Claim Handling; Delays (Claims Handling)YesInformation Furnished; Claim Settled; Additional Monies Received2012-06-19T00:00:002012-08-27T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1276Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING422NATIONWIDE LLOYDSInsuredDenial Of ClaimNoCompany Position Upheld2012-06-13T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners870Ins Co - Licensed/ActiveOrganizationINDVFOUNDATION ; GR-Claim Evaluation423BRAVO HEALTH TEXAS, INC.Contracted ProviderDelays (Claims Handling)NoInformation Furnished2012-05-07T00:00:002012-08-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&H22975Health Maintenance OrgOrganizationORGMULTIPLE INSUREDS; SENIOR CITIZEN423HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.Contracted ProviderDelays (Claims Handling)NoInformation Furnished2012-05-07T00:00:002012-08-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&H27417Ins Co - Licensed/ActiveOrganizationORGMULTIPLE INSUREDS; SENIOR CITIZEN424UNITED SERVICES AUTOMOBILE ASSOCIATIONThird PartyDelays (Claims Handling)NoAdditional Payment Expected; Question of Fact; Contract Language/Legal Issue2012-06-26T00:00:002012-08-07T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1254Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED427ALLSTATE INSURANCE COMPANYThird PartyMisleading AdvertisingNoInformation Furnished2012-06-12T00:00:002012-09-26T00:00:00Property and CasualtyMiscellaneousNo Line Specified168Ins Co - Licensed/ActiveOrganizationINDVADVERTISING428STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received; Claim Settled; Information Furnished2012-06-27T00:00:002012-09-04T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDVACV; APPRAISAL; BURDEN OF PROOF; DAMAGE DISPUTE; GR-Claim Evaluation; LOSS OF USE; TOTAL LOSS429MOLINA HEALTHCARE OF TEXAS, INC.Contracted ProviderDenial Of ClaimNoInformation Furnished; Additional Monies Received; Claim Not Clean2012-03-07T00:00:002012-12-21T00:00:00Children Health Insurance PlanAccident and HealthGroup A&HCorrespondent Person; Insured23469Health Maintenance OrgOrganizationORG430PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled2012-06-14T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED431STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredDelays (Claims Handling)NoClaim Settled2012-06-25T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person1510Ins Co - Licensed/ActiveOrganizationINDV432CIGNA HEALTHCARE OF TEXAS, INC.InsuredDelays (Claims Handling); OtherNoRecord Only2012-05-31T00:00:002012-07-17T00:00:00Health Maintenance OrgAccident and HealthIndividual A & H8294Ins Co - Licensed/ActiveOrganizationINDV435ASI LLOYDSAgentAgent HandlingNoOther2012-05-31T00:00:002012-08-21T00:00:00Property and CasualtyHomeownersCondominiumAssociated Agent; Associated Subject Agency; Insured14728Ins Co - Licensed/ActiveOrganizationINDV435CHASALOW, EMILY EAgentAgent HandlingNo2012-05-31T00:00:002012-08-21T00:00:00Property and CasualtyHomeownersCondominiumAssociated Agent; Associated Subject Agency; Insured988760AgentIndividualINDV436CYPRESS TEXAS LLOYDSInsuredUnsatisfactory Settle/OfferNoClaim Settled; Additional Monies Received; Other2012-06-26T00:00:002012-10-08T00:00:00Property and CasualtyHomeownersHomeowners18280Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; MOLD; WATER DAMAGE437GOVERNMENT EMPLOYEES INSURANCE COMPANYAttorneyDelays (Claims Handling)NoInformation Furnished2012-06-13T00:00:002012-07-23T00:00:00Property and CasualtyAutomobileIndividual Private PassCorrespondent Person; Insured2486Ins Co - Licensed/ActiveOrganizationINDV439FARMERS INSURANCE EXCHANGEInsuredRefund Of PremiumNoInformation Furnished2012-06-05T00:00:002012-08-14T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent2668Ins Co - Licensed/ActiveOrganizationINDV440GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Payment Expected2012-06-12T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation441GERMANIA FIRE & CASUALTY COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld; Question of Fact2012-06-28T00:00:002012-09-10T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured3298Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; TOTAL LOSS442OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoQuestion of Fact; Information Furnished2012-06-20T00:00:002012-08-14T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNCOOPERATIVE INSURED443ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled; Company Position Upheld; Additional Monies Received2012-06-27T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; LOSS OF USE; TOTAL LOSS444LOYA INSURANCE COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld; Information Furnished2012-06-26T00:00:002012-07-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass15643Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE; DRIVER NOT COVERED445UNITEDHEALTHCARE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Insufficient Information2012-06-21T00:00:002012-07-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV446TEXAS MUTUAL INSURANCE COMPANYNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-06-19T00:00:002013-04-18T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkCorrespondent Person; Injured Employee3500Ins Co - Licensed/ActiveOrganizationORG447WALTERSCHEID, LARRY HInsuredAgent Handling; ConversionYesReferred for Disciplinary Actn2012-06-14T00:00:002012-10-22T00:00:00Property and CasualtyMiscellaneousFederal Crop61908AgentIndividualINDVUNDERWRITING CRITERIA448UNITEDHEALTHCARE INSURANCE COMPANYRelativeDenial Of ClaimNoNo Jurisdiction2012-06-27T00:00:002012-07-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV449TEXAS MUTUAL INSURANCE COMPANYNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-06-25T00:00:002012-10-19T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Company; Correspondent Person; Insured66440WC Healthcare Provider NtwkOrganizationORG450OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)YesInformation Furnished; Additional Payment Expected; Corrective Action Taken2012-06-19T00:00:002012-09-04T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVACV; GR-Claim Evaluation; TOTAL LOSS451OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYOtherDenial Of ClaimNoCompany Position Upheld; Contract Language/Legal Issue2012-06-26T00:00:002012-08-25T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING452NATIONAL BENEFIT LIFE INSURANCE COMPANYRelativeRefund Of PremiumNoInformation Furnished2012-06-26T00:00:002012-08-13T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured3055Ins Co - Licensed/ActiveOrganizationINDV453DRIVER'S INSURANCE COMPANYInsuredRefund Of PremiumYesInformation Furnished; Premium Refund2012-06-27T00:00:002012-08-14T00:00:00Property and CasualtyAutomobileIndividual Private Pass2038Ins Co - Licensed/ActiveOrganizationINDV454BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling); Denial Of ClaimYesAdditional Monies Received; Claim Settled2012-06-04T00:00:002012-07-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationORG455STIVERS, EDDIE L IIIConsumer (Non-Insured)Agent Handling; Delays (Claims Handling)NoNo Jurisdiction; Complainant Retained Attorney2012-06-18T00:00:002012-08-20T00:00:00Property and CasualtyMiscellaneousP & C MiscAssociated Subject Company201364AgentIndividualINDV456STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferYesInformation Furnished; Additional Monies Received; Claim Settled2012-06-26T00:00:002012-08-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; DIMINISHED VALUE; GR-Claim Evaluation458USAA CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling)NoCompany Position Upheld2012-06-12T00:00:002012-12-05T00:00:00Property and CasualtyAutomobileIndividual Private Pass3607Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING459FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld2012-06-19T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation460STATE FARM LLOYDSInsuredDenial Of Claim; Unsatisfactory Settle/OfferYesAppraisal Process Invoked; Claim Settled2012-06-13T00:00:002012-08-09T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent; Insured3105Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; COVERAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF; WATER DAMAGE461USAA TEXAS LLOYD'S COMPANYInsuredDenial Of ClaimNoAdditional Monies Received; Claim Settled2012-06-20T00:00:002012-08-20T00:00:00Property and CasualtyHomeownersHomeowners14630Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; HAIL; ROOF462CONNECTICUT GENERAL LIFE INSURANCE COMPANYInsuredPremium NoticeNoRate Problem Resolved2012-06-21T00:00:002012-08-23T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2851Ins Co - Licensed/ActiveOrganizationINDV463LIBERTY COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoCompany Position Upheld; Question of Fact2012-06-14T00:00:002013-05-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass3762Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; EXAM UNDER OATH; GR-Claim Evaluation464STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYConsumer (Non-Insured)Misleading AdvertisingNoInformation Furnished2012-06-28T00:00:002012-08-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV464BURKLOW, BRIAN LEEConsumer (Non-Insured)Agent Handling; Misleading AdvertisingNoInformation Furnished2012-06-28T00:00:002012-08-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass751663AgentIndividualINDV466HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferYesClaim Settled2012-06-13T00:00:002012-07-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass2362Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING467BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredAccess to Care; Delays In AuthorizationNoInformation Furnished2012-06-26T00:00:002012-08-15T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life10047Ins Co - Licensed/ActiveOrganizationINDV469BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredPremium NoticeNoContract Language/Legal Issue2012-06-04T00:00:002012-09-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationORG470COMPREHENSIVE BEHAVIORAL CARE, INC.ProviderDelays (Claims Handling)NoNo Jurisdiction2012-06-21T00:00:002012-07-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured44120Third Party AdministratorsOrganizationORG471USAA CASUALTY INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeNoQuestion of Fact2012-06-27T00:00:002012-08-01T00:00:00Property and CasualtyAutomobileIndividual Private Pass3607Ins Co - Licensed/ActiveOrganizationINDV472NATIONWIDE LLOYDSInsuredDenial Of Claim; Liability DisputeYesClaim Settled; Additional Payment Expected; Information Furnished2012-06-26T00:00:002012-08-14T00:00:00Property and CasualtyHomeownersHomeowners870Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; HAIL; ROOF; WATER DAMAGE473GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of Claim; Unsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished; Additional Payment Expected2012-06-12T00:00:002012-07-30T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2486Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DIMINISHED VALUE; GR-Claim Evaluation474RANCHERS AND FARMERS MUTUAL INSURANCE COMPANYLienholderUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-06-20T00:00:002012-08-20T00:00:00Property and CasualtyHomeownersRental1689Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING475CORNEJO, KAROLInsuredAgent Handling; ConversionYesFailure to Timely Respond2012-06-15T00:00:002012-09-21T00:00:00Property and CasualtyHomeownersRental333869AgentIndividualINDV476ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Payment Expected2012-06-18T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDV477STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferYesClaim Settled; Additional Monies Received2012-06-13T00:00:002012-07-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; DAMAGE DISPUTE; GR-Claim Evaluation478ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYConsumer (Non-Insured)Delays (Claims Handling); Unsatisfactory Settle/OfferYesAdditional Monies Received; Information Furnished2012-06-26T00:00:002012-08-14T00:00:00Property and CasualtyHomeownersHomeowners936Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF479COMPREHENSIVE BEHAVIORAL CARE, INC.ProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-03T00:00:002012-07-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured44120Third Party AdministratorsOrganizationORG480PHILADELPHIA AMERICAN LIFE INSURANCE COMPANYInsuredMisrepresentationNoInformation Furnished2012-06-25T00:00:002012-08-01T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1777Ins Co - Licensed/ActiveOrganizationINDV480EVERETT, RAYMOND EUGENEInsuredMisrepresentationNoInformation Furnished2012-06-25T00:00:002012-08-01T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life485982AgentIndividualINDV481INSGROUP INCInsuredCancellation; Delays (Policyholder Service)NoCancel/Non-Renewal Upheld; Information Furnished2012-06-19T00:00:002012-08-22T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines13759Insurance AgencyOrganizationORGUNDERWRITING CRITERIA481COOPER, MICKEY LInsuredCancellation; Delays (Policyholder Service)NoCancel/Non-Renewal Upheld; Information Furnished2012-06-19T00:00:002012-08-22T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines186592AgentIndividualORGUNDERWRITING CRITERIA482JOHN HANCOCK LIFE & HEALTH INSURANCE COMPANYInsuredOtherNoInformation Furnished2012-06-01T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H632Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN484STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXASInsuredPremium and RatingNoCompany Position Upheld2012-06-13T00:00:002012-07-20T00:00:00Property and CasualtyAutomobileMotorcycle1506Ins Co - Licensed/ActiveOrganizationINDV485AETNA HEALTH INC.InsuredMisrepresentationNoNo Jurisdiction; Information Furnished2012-04-18T00:00:002012-08-07T00:00:00Medicare HMOAccident and HealthGroup A&HAssociated Agent3522Health Maintenance OrgOrganizationINDV485RODRIGUEZ, CHRISTINAInsuredMisrepresentationNoInformation Furnished2012-04-18T00:00:002012-08-07T00:00:00Medicare HMOAccident and HealthGroup A&HAssociated Agent770079AgentIndividualINDV486ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICAThird PartyDelays (Claims Handling)NoInformation Furnished; Additional Monies Received2012-06-25T00:00:002012-08-14T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured910Ins Co - Licensed/ActiveOrganizationINDV486REASSURE AMERICA LIFE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Additional Monies Received2012-06-25T00:00:002012-08-14T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured1228Ins Co - Licensed/ActiveOrganizationINDV487BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONPhysicianUnsatisfactory Settle/OfferNoNo Jurisdiction2012-06-26T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthXX-State Specific10047Self-Funded / ErisaOrganizationINDV489DRISCOLL CHILDREN'S HEALTH PLANProviderDenial Of ClaimNoNo Jurisdiction2012-06-21T00:00:002012-09-19T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured12460Health Maintenance OrgOrganizationORG490UNIVERSAL NORTH AMERICA INSURANCE COMPANYInsuredDenial Of Claim; Unsatisfactory Settle/OfferNoAdditional Monies Received2012-06-27T00:00:002012-07-30T00:00:00Property and CasualtyHomeownersHomeowners23526Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation491STAR INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferYesAdditional Monies Received; Information Furnished2012-06-14T00:00:002012-08-17T00:00:00Property and CasualtyAutomobileBusiness AutomobileAssociated Subject Company; Insured Company3526Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; LOSS OF USE; REPLACEMENT VEHICLE492BURLINGTON INSURANCE COMPANY, THEConsumer (Non-Insured)Denial Of ClaimNoInformation Furnished; Question of Fact2012-06-21T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileIndividual Private PassCorrespondent Person51841Ins Co - Licensed/ActiveOrganizationINDV493LIFESYNCHProviderDenial Of ClaimNoInsufficient Information2012-06-01T00:00:002012-11-27T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured44247Third Party AdministratorsOrganizationORG494UNITED DENTAL CARE OF TEXAS, INC.InsuredUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-06-25T00:00:002013-01-14T00:00:00Health Maintenance OrgAccident and HealthGroup A&H3411Health Maintenance OrgOrganizationINDV495STATE FARM LLOYDSInsuredDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-06-25T00:00:002012-07-31T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDV497BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimYesStat Pen Pd-Over 90 Dys Late; Additional Monies Received; Clean Claims Violation2012-06-18T00:00:002012-08-09T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life10047Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation497EHEALTHINSURANCE SERVICES INCInsuredDelays (Claims Handling)NoInformation Furnished2012-06-18T00:00:002012-08-09T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life16066Insurance AgencyOrganizationINDVGR-Claim Evaluation498INSURANCE 3 GROUP INCAttorneyDelays (Claims Handling)NoInformation Furnished2012-06-21T00:00:002012-07-27T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured14548Insurance AgencyOrganizationINDV498BOYD, KYLE SCOTTAttorneyDelays (Claims Handling)NoInformation Furnished2012-06-21T00:00:002012-07-27T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured298599AgentIndividualINDV499GEICO INDEMNITY COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoQuestion of Fact; Information Furnished2012-06-20T00:00:002012-09-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass2785Ins Co - Licensed/ActiveOrganizationINDV500FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled2012-06-13T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVTOTAL LOSS500GEICO GENERAL INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferYesAdditional Monies Received2012-06-13T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass2684Ins Co - Licensed/ActiveOrganizationINDVTOTAL LOSS501FIRE INSURANCE EXCHANGEInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-06-26T00:00:002012-08-30T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person2606Ins Co - Licensed/ActiveOrganizationINDVDEPRECIATION; GR-Claim Evaluation; HAIL; ROOF503COMPANION COMMERCIAL INSURANCE COMPANYInsuredCancellation; Premium and RatingNoCancel/Non-Renewal Upheld2012-06-13T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners10483Ins Co - Licensed/ActiveOrganizationINDV504TEXAS MUTUAL INSURANCE COMPANYNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-06-21T00:00:002012-10-19T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Company; Correspondent Person; Insured3500WC Healthcare Provider NtwkOrganizationORGGR-Claim Evaluation505TEXAS FARMERS INSURANCE COMPANYInsuredCust Service Claim Handling; Endorsement / Rider; Premium and Rating; Unsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-06-20T00:00:002012-08-27T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; DEDUCTIBLE; ROOF; UNDERWRITING CRITERIA506LIBERTY COUNTY MUTUAL INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferYesClaim Settled2012-06-12T00:00:002012-07-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass3762Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation507AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-06-27T00:00:002012-07-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationORG508MGA INSURANCE COMPANY, INC.Third PartyDelays (Claims Handling)YesInformation Furnished2012-06-26T00:00:002012-09-04T00:00:00Property and CasualtyAutomobileIndividual Private Pass812Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; UNCOOPERATIVE INSURED509MOLINA HEALTHCARE OF TEXAS, INC.PhysicianDenial Of ClaimNoAdditional Monies Received; Information Furnished2012-04-23T00:00:002012-08-20T00:00:00Children Health Insurance PlanAccident and HealthGroup A&HAssociated Subject Company; Correspondent Person; Insured23469Health Maintenance OrgOrganizationINDV510SCOTT AND WHITE HEALTH PLANInsuredOtherNoInformation Furnished2012-06-18T00:00:002012-09-20T00:00:00Health Maintenance OrgAccident and HealthIndividual A & H788Ins Co - Licensed/ActiveOrganizationINDV511GRAMERCY INSURANCE COMPANYLienholderDenial Of ClaimNoPolicy Not In Force; Company Position Upheld2012-06-14T00:00:002012-08-29T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Insured1062Ins Co - Licensed/ActiveOrganizationORGCOVERAGE DISPUTE; UNDERWRITING CRITERIA512TEXAS FARMERS INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished; Company Position Upheld2012-06-13T00:00:002012-08-01T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDV513COLONIAL LLOYDSInsuredPremium and RatingYesRate Problem Resolved; Information Furnished; Additional Payment Expected2012-06-18T00:00:002012-08-27T00:00:00Property and CasualtyHomeownersHomeowners768Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA514CIGNA HEALTH AND LIFE INSURANCE COMPANYInsuredDelays (Claims Handling)NoNo Jurisdiction2012-06-27T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1841Ins Co - Licensed/ActiveOrganizationINDV514CONNECTICUT GENERAL LIFE INSURANCE COMPANYInsuredDelays (Claims Handling)No2012-06-27T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Ins Co - Licensed/ActiveOrganizationINDV515SHANE FERRELL INSURANCE AGENCYThird PartyOtherYesOther2012-06-19T00:00:002012-09-19T00:00:00Property and CasualtyMiscellaneousP & C Misc66464Insurance AgencyOrganizationINDV516GOLDEN RULE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-06-19T00:00:002012-08-09T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1057Ins Co - Licensed/ActiveOrganizationINDV517CINCINNATI INSURANCE COMPANY, THEThird PartyDelays (Claims Handling)NoAdditional Payment Expected; Information Furnished2012-06-18T00:00:002012-07-30T00:00:00Property and CasualtyAutomobileBusiness Automobile2878Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; SENIOR CITIZEN518UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoRecord Only2012-06-22T00:00:002012-07-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation519BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoNo Jurisdiction2012-06-19T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV520TRANSAMERICA LIFE INSURANCE COMPANYInsuredDelays (Underwriting)NoInformation Furnished2012-06-26T00:00:002012-08-09T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1983Ins Co - Licensed/ActiveOrganizationINDV521HARSHAW, KATHERINE MOOREThird PartyCust Service Claim HandlingNoClaim Settled; Additional Payment Expected; Question of Fact2012-06-14T00:00:002012-08-06T00:00:00Property and CasualtyMiscellaneousNo Line Specified179873Claims AdjusterIndividualINDVADJUSTER'S HANDLING522ARISA INTERNATIONALAttorneyDelays (Claims Handling)NoInformation Furnished; No Jurisdiction2012-06-20T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileIndividual Private Pass66466OtherOrganizationINDV523DALLAS ISDInjured EmployeeURA Failure To NotifyNoInformation Furnished; No Jurisdiction2012-06-22T00:00:002012-11-05T00:00:00Utilization Review AgentMiscellaneousWC Non-InsuredAssociated Subject Company; Associated Subject Person; Utilization Review Agent65316Utilization Review AgentOrganizationINDV524U S LLOYDS INSURANCE COMPANYThird PartyDelays (Claims Handling); Liability Dispute; Unsatisfactory Settle/OfferNoAdditional Monies Received; Information Furnished2012-06-14T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured3177Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation525HUMANA INSURANCE COMPANYOtherDelays (Claims Handling)NoCompany Position Upheld; Claim Not Clean2012-06-07T00:00:002012-07-23T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1040Ins Co - Licensed/ActiveOrganizationORG526AETNA HEALTH INC.PhysicianUnsatisfactory Settle/OfferNoAdditional Monies Received; Information Furnished2012-06-11T00:00:002012-08-07T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Company; Correspondent Person; Insured3522Health Maintenance OrgOrganizationORG527GOLDEN RULE INSURANCE COMPANYInsuredPremium NoticeNoContract Language/Legal Issue2012-06-21T00:00:002012-08-27T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1057Ins Co - Licensed/ActiveOrganizationINDV528UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesClaim Settled2012-06-06T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV529SUPERIOR HEALTHPLAN, INC.ProviderDelays (Claims Handling)NoNo Jurisdiction2012-06-21T00:00:002012-07-30T00:00:00Health Maintenance OrgAccident and HealthGroup A&H10198Health Maintenance OrgOrganizationORG530HUMANA INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesInformation Furnished; Additional Monies Received2012-06-07T00:00:002012-08-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationORG531TEXAS STAR NETWORK/COVENTRYInjured EmployeeCust Service Claim Handling; OtherNoInformation Furnished2012-06-11T00:00:002012-07-19T00:00:00Workers Compensation NetworkAccident and HealthGroup A&HAssociated Subject Company55311WC Healthcare Provider NtwkOrganizationINDV532UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoAdditional Monies Received; Information Furnished2012-06-07T00:00:002012-08-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV533FARMERS INSURANCE EXCHANGEInsuredPremium and RatingNoInsufficient Information2012-06-04T00:00:002012-09-21T00:00:00Property and CasualtyMiscellaneousWorkers' CompensationAssociated Agent; Associated Subject Company; Correspondent Company; Correspondent Person2668Ins Co - Licensed/ActiveOrganizationORG534UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-06-19T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured1348Ins Co - Licensed/ActiveOrganizationORGMEDICARE PART D535ARCADIAN HEALTH PLAN, INC.InsuredMisrepresentationNoInformation Furnished2012-06-07T00:00:002012-11-06T00:00:00Medicare Managed Care for HMOAccident and HealthGroup A&HAssociated Agent22588Health Maintenance OrgOrganizationINDV535PODREBARAC, STEPHEN JOSEPHInsuredMisrepresentationNoInformation Furnished2012-06-07T00:00:002012-11-06T00:00:00Medicare Managed Care for HMOAccident and HealthGroup A&HAssociated Agent75919AgentIndividualINDV536SCOTT AND WHITE HEALTH PLANContracted ProviderDenial Of ClaimYesAdditional Monies Received; Information Furnished2012-06-07T00:00:002012-11-26T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured788Health Maintenance OrgOrganizationORG537LIFE INSURANCE COMPANY OF NORTH AMERICAInsuredDenial Of ClaimNoInformation Furnished; No Jurisdiction; Contract Language/Legal Issue2012-06-19T00:00:002012-08-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2157Ins Co - Licensed/ActiveOrganizationINDV538PLAZA INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoQuestion of Fact2012-06-21T00:00:002012-08-02T00:00:00Property and CasualtyAutomobileBusiness AutomobileInsured Company1586Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation538NORTH AMERICAN RISK SERVICES, INC.Third PartyDelays (Claims Handling); Denial Of ClaimNoQuestion of Fact2012-06-21T00:00:002012-08-02T00:00:00Property and CasualtyAutomobileBusiness AutomobileInsured Company125468Third Party AdministratorsOrganizationINDVGR-Claim Evaluation539PYRAMID LIFE INSURANCE COMPANY, THEProviderCust Service Claim Handling; Delays (Claims Handling)NoNo Jurisdiction2012-06-25T00:00:002012-09-19T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured1682Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN540FIRST HEALTH LIFE & HEALTH INSURANCE COMPANYInsuredDenial Of ClaimNoClaim Settled2012-06-08T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H962Ins Co - Licensed/ActiveOrganizationINDV541PRINCIPAL LIFE INSURANCE COMPANYProviderDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-06-20T00:00:002012-07-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured3032Ins Co - Licensed/ActiveOrganizationORG542TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredDenial Of ClaimNoInformation Furnished2012-06-21T00:00:002012-10-04T00:00:00Property and CasualtyHomeownersHomeowners1444Ins Co - Licensed/ActiveOrganizationINDVROOF; UNDERWRITING CRITERIA542SOMMERS, LINDA ANNInsuredAgent Handling; ConversionYesReferred for Disciplinary Actn2012-06-21T00:00:002012-10-04T00:00:00Property and CasualtyHomeownersHomeowners552196AgentIndividualINDVROOF; UNDERWRITING CRITERIA543MEGA LIFE AND HEALTH INSURANCE COMPANY, THEInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-06-25T00:00:002012-07-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2120Ins Co - Licensed/ActiveOrganizationINDV544AETNA LIFE INSURANCE COMPANYNon-Contracted ProviderUnsatisfactory Settle/OfferNoCompany Position Upheld2012-06-07T00:00:002012-10-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORGACV545ZEPEDA, PABLO JRThird PartyAgent Handling; Delays (Claims Handling)NoInformation Furnished; Corrective Action Taken2012-06-21T00:00:002012-08-26T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Associated Subject Person; Insured224510AgentIndividualINDVADJUSTER'S HANDLING546AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Company Position Upheld2012-06-25T00:00:002012-08-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG547TRAVELERS LLOYDS OF TEXAS INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished2012-06-22T00:00:002012-08-27T00:00:00Property and CasualtyHomeownersHomeowners776Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA548UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoAdditional Monies Received2012-06-25T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG550TRUSTMARK LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoInformation Furnished2012-06-20T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2732Ins Co - Licensed/ActiveOrganizationORG551MANHATTAN LIFE INSURANCE COMPANY, THEInsuredDelays (Policyholder Service)NoAdditional Monies Received; Information Furnished2012-06-08T00:00:002012-08-08T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2094Ins Co - Licensed/ActiveOrganizationINDV552AETNA LIFE INSURANCE COMPANYProviderDenial Of ClaimNoCompany Position Upheld2012-06-25T00:00:002012-08-17T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured245Ins Co - Licensed/ActiveOrganizationORG553ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling)NoContract Language/Legal Issue; Information Furnished2012-06-22T00:00:002012-08-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDV554TEXAS MUTUAL INSURANCE COMPANYInsuredURA Failed To Prov Pr-To-Pr RvNoInformation Furnished2012-06-25T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&H3500Ins Co - Licensed/ActiveOrganizationINDV555LOYA INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Payment Expected2012-06-22T00:00:002012-07-25T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured15643Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; GR-Claim Evaluation556CONTINENTAL GENERAL INSURANCE COMPANYRelativeUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-06-08T00:00:002012-08-20T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2817Ins Co - Licensed/ActiveOrganizationINDVALZHEIMER; SENIOR CITIZEN557PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoContract Language/Legal Issue2012-06-22T00:00:002012-08-07T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1708Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; EXAM UNDER OATH558BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-06-19T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGEMERGENCY CARE559PRUDENTIAL INSURANCE COMPANY OF AMERICA, THEInsuredCash ValueNoAdditional Monies Received; Information Furnished2012-06-25T00:00:002012-08-13T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1729Ins Co - Licensed/ActiveOrganizationINDV560DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoInformation Furnished2012-06-22T00:00:002013-01-28T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2038Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation; UNCOOPERATIVE INSURED561AMERITAS LIFE INSURANCE CORP.InsuredCash Value; Premium NoticeYesPolicy Issued/Restored; Information Furnished2012-06-25T00:00:002012-10-04T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life3034Ins Co - Licensed/ActiveOrganizationINDV562OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished2012-06-22T00:00:002012-08-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING564ASSURITY LIFE INSURANCE COMPANYInsuredXX-Coverage QuestionNoInformation Furnished; Contract Language/Legal Issue2012-06-08T00:00:002012-07-23T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2533Ins Co - Licensed/ActiveOrganizationINDV565AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-06-25T00:00:002012-07-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationORG567HOCHHEIM PRAIRIE FARM MUTUAL INSURANCE ASSOCIATIONInsuredDenial Of ClaimNoCompany Position Upheld; Information Furnished2012-06-22T00:00:002012-10-18T00:00:00Property and CasualtyHomeownersHomeowners2350Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation569AETNA LIFE INSURANCE COMPANYNon-Contracted ProviderUnsatisfactory Settle/OfferNoInformation Furnished; Additional Payment Expected2012-06-07T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationORG570PHOENIX LIFE INSURANCE COMPANYInsuredCash ValueNoInformation Furnished2012-06-25T00:00:002012-09-12T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities1785Ins Co - Licensed/ActiveOrganizationINDV571HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoAdditional Payment Expected; Information Furnished2012-06-22T00:00:002012-08-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass2362Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING572AMERICAN MERCURY LLOYD'S INSURANCE COMPANYRelativeDelays (Claims Handling)NoContract Language/Legal Issue; Question of Fact; Additional Payment Expected2012-06-22T00:00:002012-12-10T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent; Associated Subject Person; Insured3443Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING573BOJADO, EZEQUIEL GONZALOInsuredMisrepresentationYesInformation Furnished2012-06-07T00:00:002012-09-19T00:00:00Medicare HMOAccident and HealthIndividual A & H24849AgentIndividualINDV573WELLCARE OF TEXAS, INC.InsuredMisrepresentationNoNo Jurisdiction2012-06-07T00:00:002012-09-19T00:00:00Medicare HMOAccident and HealthIndividual A & H28079Health Maintenance OrgOrganizationINDV574AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-06-19T00:00:002012-07-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORGMULTIPLE INSUREDS575TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredRefusal to InsureNoPolicy Issued/Restored; Information Furnished2012-06-22T00:00:002012-08-17T00:00:00Property and CasualtyHomeownersHomeowners1444TWIAOrganizationINDV576CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished; Additional Monies Received2012-06-25T00:00:002012-08-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Ins Co - Licensed/ActiveOrganizationORGBUNDLING; GR-Claim Evaluation578JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.)InsuredXX-Coverage QuestionNoInformation Furnished2012-06-08T00:00:002012-07-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1148Ins Co - Licensed/ActiveOrganizationINDV579CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-06-19T00:00:002012-07-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORGMULTIPLE INSUREDS580HUMANA INSURANCE COMPANYOtherClaim Recoding/Bundling; Unsatisfactory Settle/OfferNoInformation Furnished2012-06-08T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationORG581UNION SECURITY INSURANCE COMPANYProviderDelays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-06-25T00:00:002012-08-08T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1215Ins Co - Licensed/ActiveOrganizationINDV582PRINCIPAL LIFE INSURANCE COMPANYInsuredDenial Of Claim; Unsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-06-25T00:00:002012-09-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&H3032Ins Co - Licensed/ActiveOrganizationINDVEXPERIMENTAL/INVESTIGATIONAL583UMR, INC.ProviderDelays (Claims Handling)NoNo Jurisdiction2012-06-08T00:00:002012-07-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&H23490Ins Co - Licensed/ActiveOrganizationORG584TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredDelays (Claims Handling)NoInformation Furnished2012-06-18T00:00:002012-08-17T00:00:00Property and CasualtyHomeownersHomeownersThird Party Admin-Non Licensed1444Ins Co - Licensed/ActiveOrganizationINDV585AETNA LIFE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received2012-06-08T00:00:002012-07-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDVCANCER586UNITED STATES FIRE INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; Information Furnished; Question of Fact2012-06-25T00:00:002012-08-27T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life50626Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation587HUMANA HEALTH PLAN OF TEXAS, INC.ProviderDelays (Claims Handling); Prompt PayYesStat Pen Pd-Over 90 Dys Late; Additional Monies Received2012-06-20T00:00:002012-09-17T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured702Health Maintenance OrgOrganizationINDV588BEST LIFE AND HEALTH INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld2012-06-25T00:00:002012-08-31T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H819Ins Co - Licensed/ActiveOrganizationINDV589CIGNA HEALTH AND LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-06-25T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1841Ins Co - Licensed/ActiveOrganizationORG590AETNA LIFE INSURANCE COMPANYProviderDenial Of ClaimNoClaim Settled2012-06-25T00:00:002012-08-20T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life245Ins Co - Licensed/ActiveOrganizationORG591ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Claim Settled2012-06-21T00:00:002012-07-31T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured936Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED592STATE FARM FIRE AND CASUALTY COMPANYInsuredExcessive Rates; Premium and RatingNoCompany Position Upheld2012-06-21T00:00:002012-08-13T00:00:00Property and CasualtyLiabilityUmbrella1507Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA593AAA TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoContract Language/Legal Issue2012-06-21T00:00:002012-07-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass2286Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; SUBROGATION593CHARTER OAK FIRE INSURANCE COMPANY, THEThird PartyDenial Of ClaimNoQuestion of Fact2012-06-21T00:00:002012-07-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass2918Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; SUBROGATION594BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoNo Jurisdiction2012-06-25T00:00:002012-07-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationORG595AAA TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredXX-Coverage QuestionNoCompany Position Upheld; Information Furnished2012-06-21T00:00:002012-07-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass2286Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; REPLACEMENT VEHICLE596BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-06-25T00:00:002012-08-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG597METROPOLITAN LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoAdditional Monies Received2012-06-25T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H13191Ins Co - Licensed/ActiveOrganizationINDV598UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-06-25T00:00:002012-07-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV599CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-06-25T00:00:002012-07-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Ins Co - Licensed/ActiveOrganizationORG600BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderSB418 Rule ViolationNoInformation Furnished2012-06-25T00:00:002013-01-22T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationORG601UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)YesAdditional Monies Received; Information Furnished; Stat Pen Pd-46 To 90 Dys Late2012-06-25T00:00:002012-08-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG603TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredCancellationYesPolicy Issued/Restored2012-06-29T00:00:002012-07-31T00:00:00Property and CasualtyHomeownersHomeownersGR Elected Official1444TWIAOrganizationINDV603PURDOM, JAMES DAVIDInsuredOtherNoInformation Furnished2012-06-29T00:00:002012-07-31T00:00:00Property and CasualtyHomeownersHomeownersGR Elected Official146470AgentIndividualINDV604FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld2012-06-21T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDV605ASSURITY LIFE INSURANCE COMPANYConsumer (Non-Insured)OtherNoInsufficient Information2012-06-06T00:00:002013-03-12T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2533Ins Co - Licensed/ActiveOrganizationINDV606AETNA LIFE INSURANCE COMPANYRelativeOtherYesPolicy Issued/Restored; Additional Monies Received2012-06-08T00:00:002012-10-30T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life245Ins Co - Licensed/ActiveOrganizationINDV607TEXAS FARMERS INSURANCE COMPANYInsuredPremium and RatingYesInformation Furnished2012-06-29T00:00:002012-07-27T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDV608WELLINGTON INSURANCE COMPANYInsuredDenial Of ClaimYesAdditional Monies Received; Information Furnished2012-06-21T00:00:002012-08-17T00:00:00Property and CasualtyHomeownersHomeowners18251Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; HAIL; ROOF609FIDELITY SECURITY LIFE INSURANCE COMPANYPhysicianDelays (Claims Handling)YesAdditional Monies Received; Information Furnished2012-06-06T00:00:002012-08-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2592Ins Co - Licensed/ActiveOrganizationINDV610Chevron-TexacoConsumer (Non-Insured)Not Within TDI JurisdictionNoNo Jurisdiction2012-06-26T00:00:002012-08-28T00:00:00Property and CasualtyLiabilityXX-GeneralCorrespondent Company68270EmployerOrganizationINDV612UNITEDHEALTHCARE INSURANCE COMPANYInsuredDenial Of ClaimYesAdditional Monies Received2012-06-04T00:00:002012-07-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV613HOCHHEIM PRAIRIE CASUALTY INSURANCE COMPANYInsuredCancellationNoInformation Furnished; Cancel/Non-Renewal Upheld2012-06-13T00:00:002012-08-09T00:00:00Property and CasualtyHomeownersHomeowners1152Ins Co - Licensed/ActiveOrganizationINDV613HOCHHEIM PRAIRIE FARM MUTUAL INSURANCE ASSOCIATIONInsuredCancellationNoInformation Furnished; Cancel/Non-Renewal Upheld2012-06-13T00:00:002012-08-09T00:00:00Property and CasualtyHomeownersHomeowners2350Ins Co - Licensed/ActiveOrganizationINDV614PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYNon-Contracted ProviderDelays (Claims Handling)NoInformation Furnished2012-06-08T00:00:002012-08-20T00:00:00Life, Accident and HealthAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation614HMA, INC.Non-Contracted ProviderDelays (Claims Handling)NoInformation Furnished2012-06-08T00:00:002012-08-20T00:00:00Life, Accident and HealthAutomobileIndividual Private Pass51688OtherOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation615GARRISON PROPERTY AND CASUALTY INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeNoInformation Furnished; Question of Fact2012-06-21T00:00:002012-08-20T00:00:00Property and CasualtyAutomobileIndividual Private Pass1697Ins Co - Licensed/ActiveOrganizationINDV616SAFECO INSURANCE COMPANY OF INDIANAInsuredPremium and RatingNoContract Language/Legal Issue2012-06-28T00:00:002012-10-12T00:00:00Property and CasualtyHomeownersHomeownersInsured Company2496Ins Co - Licensed/ActiveOrganizationINDV616MARTIN, BILLY RAYFORDInsuredDelays (Policyholder Service)NoInformation Furnished2012-06-28T00:00:002012-10-12T00:00:00Property and CasualtyHomeownersHomeownersInsured Company6433AgentIndividualINDV617UNIVERSAL NORTH AMERICA INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferYesAdditional Payment Expected; Information Furnished2012-06-14T00:00:002012-08-10T00:00:00Property and CasualtyHomeownersHomeowners23526Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; HAIL; ROOF618FORETHOUGHT LIFE INSURANCE COMPANYInsuredCancellationNoCancel/Non-Renewal Upheld2012-06-04T00:00:002012-08-06T00:00:00Life, Accident and HealthAccident and HealthGroup A&H728Ins Co - Licensed/ActiveOrganizationINDV619BANKERS LIFE AND CASUALTY COMPANYThird PartyDelays (Claims Handling)NoRecord Only2012-06-27T00:00:002012-08-21T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life3030Ins Co - Licensed/ActiveOrganizationORG621TRAVELERS LLOYDS INSURANCE COMPANY, THEThird PartyDenial Of ClaimNoInformation Furnished2012-06-28T00:00:002012-08-15T00:00:00Property and CasualtyLiabilityGeneral LiabilityInsured Company777Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE622NATIONAL WESTERN LIFE INSURANCE COMPANYAttorneyMisrepresentationNoCompany Position Upheld2012-05-31T00:00:002012-08-07T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesInsured1933Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN622ASSURITY LIFE INSURANCE COMPANYAttorneyMisrepresentationNoCompany Position Upheld2012-05-31T00:00:002012-08-07T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesInsured2533Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN622AVIVA LIFE AND ANNUITY COMPANYAttorneyMisrepresentationNoPolicy Not In Force2012-05-31T00:00:002012-08-07T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesInsured2959Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN622LAJUDES, JAMES JAttorneyAgent HandlingNoQuestion of Fact2012-05-31T00:00:002012-08-07T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesInsured85556AgentIndividualORGSENIOR CITIZEN623ALLSTATE INDEMNITY COMPANYThird PartyDelays (Claims Handling); Liability DisputeNoQuestion of Fact; Additional Payment Expected; Information Furnished2012-06-26T00:00:002012-08-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass167Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNCOOPERATIVE INSURED623USAA CASUALTY INSURANCE COMPANYThird PartyCust Service Claim HandlingNoInformation Furnished2012-06-26T00:00:002012-08-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass3607Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNCOOPERATIVE INSURED624LOYA INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished2012-06-18T00:00:002012-08-23T00:00:00Property and CasualtyAutomobileIndividual Private Pass15643Ins Co - Licensed/ActiveOrganizationINDV626AMERICAN RISK INSURANCE COMPANY, INC.InsuredUnsatisfactory Settle/OfferYesInformation Furnished; Additional Payment Expected2012-06-13T00:00:002012-08-21T00:00:00Property and CasualtyHomeownersHomeowners27377Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DEDUCTIBLE; HAIL; ROOF; WATER DAMAGE627DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled; Additional Payment Expected; Information Furnished2012-06-14T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; UNCOOPERATIVE INSURED628DAIRYLAND COUNTY MUTUAL INSURANCE COMPANY OF TEXASInsuredDelays (Policyholder Service); OtherYesCorrective Action Taken; Information Furnished2012-06-21T00:00:002012-10-02T00:00:00Property and CasualtyAutomobileIndividual Private Pass2737Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; UNDERWRITING CRITERIA629NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA.Third PartyDelays (Claims Handling)YesAdditional Payment Expected; Information Furnished2012-06-28T00:00:002012-08-23T00:00:00Property and CasualtyLiabilityGeneral LiabilityInsured Company1931Ins Co - Licensed/ActiveOrganizationINDV630COMMUNITY HEALTH CHOICE, INC.Contracted ProviderDenial Of ClaimYesInformation Furnished; Additional Monies Received2012-06-05T00:00:002013-02-04T00:00:00Children Health Insurance PlanAccident and HealthGroup A&HCorrespondent Company; Correspondent Person; Insured10148Health Maintenance OrgOrganizationORG631LIFE INSURANCE COMPANY OF THE SOUTHWESTInsuredDelays (Policyholder Service)NoContract Language/Legal Issue; Information Furnished2012-06-08T00:00:002012-07-24T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities2158Ins Co - Licensed/ActiveOrganizationINDV631TALLEY, KENTDOLPHUS LAMONTInsuredConversion; Misrepresentation; XX-Fraud/ForgeryNoQuestion of Fact2012-06-08T00:00:002012-07-24T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities1128836AgentIndividualINDV632INTERNATIONAL MEDICAL ADMINISTRATORS, INC.ProviderDenial Of ClaimYesClaim Settled2012-06-05T00:00:002012-07-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured21814Insurance AgencyOrganizationORG633COVENTRY HEALTH CARE WORKERS' COMPENSATION, INC.Injured EmployeeXX-State SpecificNo2012-05-21T00:00:002012-09-19T00:00:00Workers' CompensationAccident and HealthGroup A&HAssociated Agent; Associated Subject Company44323WC Healthcare Provider NtwkOrganizationINDV633AMERICA FIRST INSURANCE COMPANYInjured EmployeeDenial Of ClaimNoInformation Furnished2012-05-21T00:00:002012-09-19T00:00:00Workers' CompensationAccident and HealthGroup A&HAssociated Agent; Associated Subject Company66728Ins Co - Licensed/ActiveOrganizationINDV634ALLSTATE COUNTY MUTUAL INSURANCE COMPANYThird PartyLiability DisputeYesInformation Furnished; Additional Monies Received; Question of Fact2012-06-28T00:00:002012-09-05T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent2228Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COMPARATIVE NEGLIGENCE; GR-Claim Evaluation635MERCURY COUNTY MUTUAL INSURANCE COMPANYAttorneyDelays (Claims Handling)NoInformation Furnished; Company Position Upheld2012-06-14T00:00:002012-08-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured1693Ins Co - Licensed/ActiveOrganizationINDV635LEMON INSURANCE AGENCY INCAttorneyAgent HandlingYesInformation Furnished2012-06-14T00:00:002012-08-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured4299Insurance AgencyOrganizationINDV636STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoComplainant Retained Attorney; Information Furnished2012-06-21T00:00:002012-08-09T00:00:00Property and CasualtyAutomobileIndividual Private PassCorrespondent Person1510Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation637FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Payment Expected; Complainant Retained Attorney; Information Furnished2012-06-13T00:00:002012-07-30T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2623Ins Co - Licensed/ActiveOrganizationINDV639ALLSTATE TEXAS LLOYD'SInsuredPremium and RatingNoInsufficient Information2012-06-28T00:00:002012-08-24T00:00:00Property and CasualtyHomeownersHomeowners3721Ins Co - Licensed/ActiveOrganizationINDV640COLONIAL COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled; Additional Monies Received2012-06-28T00:00:002012-08-23T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2455Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; REPLACEMENT VEHICLE641HEALTHPARTNERS ADMINISTRATORS, INC.ProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-06-06T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person; Insured54458OtherOrganizationINDV642LOYA INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-06-28T00:00:002012-08-28T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent15643Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation643AETNA LIFE INSURANCE COMPANYProviderOtherYesInformation Furnished2012-06-05T00:00:002012-07-26T00:00:00Life, Accident and HealthMiscellaneousNo Line Specified245Ins Co - Licensed/ActiveOrganizationORG644FIRE INSURANCE EXCHANGEInsuredDelays (Policyholder Service)YesInformation Furnished2012-06-14T00:00:002012-08-16T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent2606Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED645AGCS MARINE INSURANCE COMPANYInsuredDelays (Claims Handling)NoContract Language/Legal Issue2012-06-06T00:00:002012-08-02T00:00:00Property and CasualtyHomeownersHomeowners941Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE645WRENN, R MICHAELInsuredAgent HandlingYesReferred for Disciplinary Actn2012-06-06T00:00:002012-08-02T00:00:00Property and CasualtyHomeownersHomeowners119071AgentIndividualINDVDEDUCTIBLE646LIBERTY COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished2012-06-13T00:00:002012-08-03T00:00:00Property and CasualtyAutomobileIndividual Private Pass3762Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA647TURPIN, ANTHONY DAVIDInsuredXX-Coverage QuestionNoAdditional Monies Received2012-06-13T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners115064AgentIndividualINDVSENIOR CITIZEN648BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONRelativeDenial Of ClaimNoContract Language/Legal Issue2012-06-06T00:00:002012-08-27T00:00:00Health Maintenance OrgAccident and HealthGroup A&H10047Health Maintenance OrgOrganizationINDV649COLONIAL COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoAdditional Payment Expected; Company Position Upheld; Question of Fact2012-06-26T00:00:002012-08-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass2455Ins Co - Licensed/ActiveOrganizationINDVAFTERMARKET PARTS; APPRAISAL; GR-Claim Evaluation; TOTAL LOSS650AMERICAN ACCESS CASUALTY COMPANYOtherDelays (Claims Handling); Unsatisfactory Settle/OfferYesInformation Furnished; Claim Settled2012-06-26T00:00:002012-08-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass30332Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation651HOMELAND INSURANCE COMPANY OF NEW YORKInsuredRefund Of PremiumYesInformation Furnished; Additional Payment Expected; Contract Language/Legal Issue2012-06-14T00:00:002012-07-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&H55803Ins Co - Licensed/ActiveOrganizationORG652AMERICAN BANKERS INSURANCE COMPANY OF FLORIDARelativeDenial Of ClaimNoCompany Position Upheld2012-05-28T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersMobile HomeownerAssociated Subject Company; Insured176Ins Co - Licensed/ActiveOrganizationINDV653AETNA LIFE INSURANCE COMPANYProviderDenial Of ClaimNoCompany Position Upheld2012-06-06T00:00:002012-07-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation654RELIASTAR LIFE INSURANCE COMPANYInsuredMisrepresentationNoNo Jurisdiction; Information Furnished2012-06-08T00:00:002012-07-25T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities1863Ins Co - Licensed/ActiveOrganizationINDV655BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONPhysicianUnsatisfactory Settle/Offer; XX-RecoupmentNoOther2012-06-26T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV656AMERICAN RISK INSURANCE COMPANY, INC.InsuredDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-06-13T00:00:002012-11-02T00:00:00Property and CasualtyHomeownersHomeowners27377Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE657TEXAS HEALTH INSURANCE POOLRelativeDenial Of ClaimNoAdditional Monies Received2012-05-10T00:00:002012-08-28T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H9031Ins Co - Licensed/ActiveOrganizationINDV658STATE FARM LLOYDSInsuredPremium NoticeNoInformation Furnished2012-06-26T00:00:002012-07-23T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDV659HCH ADMINISTRATION, INC.PhysicianUnsatisfactory Settle/OfferYesClaim Settled2012-06-25T00:00:002012-12-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&H20256Ins Co - Licensed/ActiveOrganizationINDV660LOYA INSURANCE COMPANYMilitary PersonnelDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue; Company Position Upheld2012-06-15T00:00:002012-08-15T00:00:00Property and CasualtyAutomobileIndividual Private PassCorrespondent Person; GR Elected Official; Insured15643Ins Co - Licensed/ActiveOrganizationINDVDRIVER NOT COVERED661AMERICO FINANCIAL LIFE AND ANNUITY INSURANCE COMPANYBeneficiaryMisrepresentationNoQuestion of Fact2012-06-06T00:00:002012-08-07T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesDeceased Person2897Ins Co - Licensed/ActiveOrganizationINDV661FIOCCHI, WILLIAM PBeneficiaryMisrepresentationNoQuestion of Fact2012-06-06T00:00:002012-08-07T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesDeceased Person370342AgentIndividualINDV662LAFAYETTE LIFE INSURANCE COMPANY, THERelativeMisrepresentationNoQuestion of Fact; Contract Language/Legal Issue; Information Furnished2012-06-05T00:00:002012-07-20T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2188Ins Co - Licensed/ActiveOrganizationINDV662MCKEOWN, GEORGE WILLIAM JRRelativeMisrepresentationNoQuestion of Fact; Information Furnished2012-06-05T00:00:002012-07-20T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life684459AgentIndividualINDV663OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYAttorneyDelays (Claims Handling)NoAdditional Payment Expected; Company Position Upheld2012-06-26T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation; TOTAL LOSS663PRONTO INSURANCEAttorneyDelays (Claims Handling)No2012-06-26T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass37095Insurance AgencyOrganizationORGADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation; TOTAL LOSS664FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredAgent HandlingNoQuestion of Fact; Information Furnished; Company Position Upheld2012-06-13T00:00:002012-08-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDV664ZAVALA, ERNESTOInsuredAgent HandlingNoQuestion of Fact; Information Furnished2012-06-13T00:00:002012-08-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass340138AgentIndividualINDV665CENTRAL UNITED LIFE INSURANCE COMPANYOtherDenial Of Claim; Unsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-06-08T00:00:002012-07-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&H947Ins Co - Licensed/ActiveOrganizationORG666ASI LLOYDSInsuredDelays (Claims Handling)YesAdditional Payment Expected; Information Furnished2012-06-25T00:00:002012-08-28T00:00:00Property and CasualtyHomeownersHomeowners14728Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING668COVENTRY HEALTH CARE WORKERS COMPENSATION, INC.ProviderDen/N-Pymt MD Nec Trmt N-EmrgNoInformation Furnished2012-06-19T00:00:002013-04-18T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Company; Insured55168WC Healthcare Provider NtwkOrganizationORG669INDEPENDENCE TITLE COMPANYConsumer (Non-Insured)XX-Coverage Question; XX-State SpecificNoCompany Position Upheld2012-06-25T00:00:002012-09-19T00:00:00Property and CasualtyMiscellaneousTitle InsuranceAssociated Subject Company66531AgentOrganizationINDV670PRAETORIAN INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished2012-06-26T00:00:002012-08-31T00:00:00Property and CasualtyHomeownersHomeowners687Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING672BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredLifetime/Annual LimitsNoNo Jurisdiction; Contract Language/Legal Issue2012-06-15T00:00:002012-07-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company10047Ins Co - Licensed/ActiveOrganizationINDV673TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredDenial Of ClaimNoInformation Furnished2012-06-13T00:00:002012-10-05T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company1444Ins Co - Licensed/ActiveOrganizationINDVHAIL; ROOF; UNDERWRITING CRITERIA673YOUNG, LUMMIEInsuredAgent Handling; Conversion; Misrepresentation; Unauthorized ActsYesReferred for Disciplinary Actn; Information Furnished2012-06-13T00:00:002012-10-05T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company66141AgentIndividualINDVHAIL; ROOF; UNDERWRITING CRITERIA676SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIAInsuredPremium and RatingNoInformation Furnished2012-05-16T00:00:002012-08-08T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H3587Ins Co - Licensed/ActiveOrganizationINDV677TRAVELERS LLOYDS OF TEXAS INSURANCE COMPANYInsuredPremium and RatingNoContract Language/Legal Issue; Information Furnished2012-06-18T00:00:002012-08-24T00:00:00Property and CasualtyMiscellaneousP & C Misc776Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE678ACCC INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld2012-06-26T00:00:002012-08-28T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation; MULTIPLE INSUREDS; POLICY EXCLUSION; UNDERWRITING CRITERIA678HOLMES, WILLIE DInsuredAgent HandlingNoInformation Furnished; Company Position Upheld2012-06-26T00:00:002012-08-28T00:00:00Property and CasualtyAutomobileIndividual Private Pass18466AgentIndividualINDVCOVERAGE DISPUTE; GR-Claim Evaluation; MULTIPLE INSUREDS; POLICY EXCLUSION; UNDERWRITING CRITERIA679STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredAgent Handling; Cancellation; Denial Of ClaimYesCompany Position Upheld; Cancel/Non-Renewal Upheld; Information Furnished2012-06-15T00:00:002012-11-06T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent1510Ins Co - Licensed/ActiveOrganizationINDVHAIL681UNITRIN COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished; Additional Payment Expected2012-06-21T00:00:002012-08-28T00:00:00Property and CasualtyAutomobileIndividual Private Pass1856Ins Co - Licensed/ActiveOrganizationINDV682SAFECO INSURANCE COMPANY OF INDIANAInsuredCust Service Claim HandlingNoInformation Furnished2012-06-26T00:00:002012-08-10T00:00:00Property and CasualtyHomeownersHomeowners2496Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; HAIL; ROOF683FARMERS INSURANCE EXCHANGEInsuredDenial Of ClaimNoCompany Position Upheld2012-06-26T00:00:002013-02-08T00:00:00Property and CasualtyHomeownersHomeowners2668Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation684ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Company Position Upheld; Question of Fact2012-06-15T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person936Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation685GROUP & PENSION ADMINISTRATORS, INC.InsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-06-26T00:00:002012-07-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&H32390Third Party AdministratorsOrganizationINDV687COOK CHILDREN'S HEALTH PLANProviderDenial Of ClaimYesInformation Furnished2012-06-01T00:00:002012-09-19T00:00:00Children Health Insurance PlanAccident and HealthGroup A&HAssociated Subject Company; Insured8688WC Healthcare Provider NtwkOrganizationORG688FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-06-27T00:00:002012-08-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNDERWRITING CRITERIA689FOREMOST LLOYDS OF TEXASInsuredPremium and RatingNoRate Problem Resolved; Information Furnished2012-06-20T00:00:002012-07-31T00:00:00Property and CasualtyHomeownersHomeowners698Ins Co - Licensed/ActiveOrganizationINDV690AAA TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyXX-State SpecificNoAdditional Payment Expected; Information Furnished2012-06-18T00:00:002012-07-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass2286Ins Co - Licensed/ActiveOrganizationINDV691HOME STATE COUNTY MUTUAL INSURANCE COMPANYAttorneyDelays (Claims Handling)NoAdditional Monies Received2012-06-25T00:00:002012-08-17T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured2362Ins Co - Licensed/ActiveOrganizationINDV692AAA TEXAS COUNTY MUTUAL INSURANCE COMPANYConsumer (Non-Insured)Delays (Claims Handling); Unsatisfactory Settle/OfferYesQuestion of Fact; Additional Payment Expected; Information Furnished2012-06-15T00:00:002012-08-02T00:00:00Property and CasualtyHomeownersHomeownersInsured2286Ins Co - Licensed/ActiveOrganizationINDVDEPRECIATION; OVERHEAD AND PROFIT; ROOF693CELTIC INSURANCE COMPANYInsuredDenial Of ClaimYesAdditional Payment Expected2012-06-27T00:00:002012-08-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured93Ins Co - Licensed/ActiveOrganizationINDV694COMPANION LIFE INSURANCE COMPANYInsuredRefund Of PremiumNoInformation Furnished; Premium Refunded2012-06-22T00:00:002012-09-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&H3710Ins Co - Licensed/ActiveOrganizationINDV695COOK CHILDREN'S HEALTH PLANProviderDelays (Claims Handling)YesAdditional Payment Expected2012-06-01T00:00:002012-08-14T00:00:00Children Health Insurance PlanAccident and HealthGroup A&HAssociated Subject Company; Correspondent Person; Insured8688Health Maintenance OrgOrganizationORG696GERMANIA FARM MUTUAL INSURANCE ASSOCIATIONInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-06-13T00:00:002012-08-31T00:00:00Property and CasualtyHomeownersHomeowners2468Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; POLICY EXCLUSION; ROOF697GEICO INDEMNITY COMPANYConsumer (Non-Insured)XX-Inadequate Reimbursemt/Rate; XX-Unfair NegotiationNoQuestion of Fact2012-04-26T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass2785Ins Co - Licensed/ActiveOrganizationINDV698GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredDenial Of ClaimNoClaim Settled; Additional Monies Received; Information Furnished2012-06-27T00:00:002012-08-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVAFTERMARKET PARTS; COVERAGE DISPUTE699SCHUMMER, JEFFREY MARTINInsuredNon-Disclosure Of CoverageNoInformation Furnished2012-06-22T00:00:002012-09-06T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines767588AgentIndividualINDV700STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYProviderAssignment of Benefits; Delays (Claims Handling)YesInformation Furnished; Additional Payment Expected; Additional Monies Received2012-06-22T00:00:002012-08-17T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured1510Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING701ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoAdditional Monies Received; Company Position Upheld2012-06-22T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Correspondent Person; Insured9825Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; UNCOOPERATIVE INSURED702MGA INSURANCE COMPANY, INC.Third PartyDenial Of ClaimNoQuestion of Fact; Information Furnished2012-06-22T00:00:002012-08-28T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Insured812Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF703INSURANCE 3 GROUP INCAttorneyAgent HandlingNoInformation Furnished2012-06-21T00:00:002012-08-01T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured14548Insurance AgencyOrganizationINDV703KING, KYLE FREDERICKAttorneyAgent HandlingNoInformation Furnished2012-06-21T00:00:002012-08-01T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured890007AgentIndividualINDV704AMERICAN GUARANTEE AND LIABILITY INSURANCE COMPANYThird PartyDenial Of ClaimYesInformation Furnished2012-06-22T00:00:002012-08-25T00:00:00Property and CasualtyAutomobileXX-Commercial155Ins Co - Licensed/ActiveOrganizationINDV705UNITEDHEALTHCARE INSURANCE COMPANYInsuredXX-Coverage QuestionYesInformation Furnished; Contract Language/Legal Issue2012-06-26T00:00:002012-07-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV706ALTERRA EXCESS & SURPLUS INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-06-15T00:00:002012-09-27T00:00:00Property and CasualtyLiabilityGeneral LiabilityAssociated Agent; Associated Subject Agency; Insured48727Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE706MILLER, DON MICHAELThird PartyCust Service Claim Handling; Denial Of ClaimYesFailure to Timely Respond; Referred To2012-06-15T00:00:002012-09-27T00:00:00Property and CasualtyLiabilityGeneral LiabilityAssociated Agent; Associated Subject Agency; Insured115737AgentIndividualINDVCOVERAGE DISPUTE707OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld; Contract Language/Legal Issue2012-06-26T00:00:002012-08-20T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Associated Subject Person; Insured1823Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation708REASSURE AMERICA LIFE INSURANCE COMPANYRelativeDelays (Policyholder Service)NoInformation Furnished2012-06-22T00:00:002012-08-13T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured1228Ins Co - Licensed/ActiveOrganizationINDV709METROPOLITAN LIFE INSURANCE COMPANYPhysicianDelays (Claims Handling)NoClaim Settled2012-06-20T00:00:002012-08-06T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life13191Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation710HOME STATE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Liability DisputeNoInformation Furnished; Question of Fact2012-06-18T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileIndividual Private Pass2362Ins Co - Licensed/ActiveOrganizationINDV711NATIONAL INTERSTATE INSURANCE COMPANYAttorneyDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished2012-06-22T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileBusiness AutomobileAssociated Subject Company; Insured Company3548Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; APPRAISAL; BURDEN OF PROOF; DAMAGE DISPUTE; DIMINISHED VALUE; GR-Claim Evaluation; TOTAL LOSS; UNDERWRITING CRITERIA711ALEXANDER INSURANCE AGENCY INCAttorneyDelays (Claims Handling)NoInformation Furnished2012-06-22T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileBusiness AutomobileAssociated Subject Company; Insured Company5085Insurance AgencyOrganizationORGADJUSTER'S HANDLING; APPRAISAL; BURDEN OF PROOF; DAMAGE DISPUTE; DIMINISHED VALUE; GR-Claim Evaluation; TOTAL LOSS; UNDERWRITING CRITERIA712NATIONAL LLOYDS INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished; Claim Settled2012-06-13T00:00:002012-08-20T00:00:00Property and CasualtyHomeownersHomeowners1914Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; HAIL713HUMANA INSURANCE COMPANYProviderDelays (Claims Handling)NoInformation Furnished2012-06-20T00:00:002012-08-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORG714SUPERIOR HEALTHPLAN, INC.ProviderDenial Of ClaimNoInformation Furnished; Additional Monies Received2012-06-06T00:00:002012-07-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person; Insured10198Health Maintenance OrgOrganizationORG716MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANYInsuredCash ValueNoInformation Furnished2012-06-06T00:00:002012-07-17T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2115Ins Co - Licensed/ActiveOrganizationINDV717PYRAMID LIFE INSURANCE COMPANY, THEPhysicianUnsatisfactory Settle/OfferNoAdditional Monies Received2012-06-06T00:00:002012-08-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1682Ins Co - Licensed/ActiveOrganizationINDV718SHIPLEY, ROBERT MARKThird PartyUnsatisfactory Settle/OfferYesFailure to Timely Respond2012-06-26T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company935167Claims AdjusterIndividualINDV720BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoAdditional Payment Expected; Contract Language/Legal Issue2012-06-18T00:00:002012-07-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV721HALLMARK COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoClaim Settled; Additional Monies Received2012-06-15T00:00:002012-08-02T00:00:00Property and CasualtyAutomobileBusiness Automobile1505Ins Co - Licensed/ActiveOrganizationINDVLOSS OF USE722FARMERS INSURANCE EXCHANGEInsuredDenial Of ClaimYesContract Language/Legal Issue; Company Position Upheld2012-06-26T00:00:002012-10-13T00:00:00Property and CasualtyLiabilityGeneral Liability2668Ins Co - Licensed/ActiveOrganizationINDV724NATIONAL GENERAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Corrective Action Taken2012-06-22T00:00:002012-08-25T00:00:00Property and CasualtyAutomobileMotorhome/Recreational Veh1953Ins Co - Licensed/ActiveOrganizationINDV725STATE OFFICE OF RISK MANAGEMENTInjured EmployeeContinuity Of TreatmentNoInformation Furnished2012-05-21T00:00:002013-04-01T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Company32696Third Party AdministratorsOrganizationINDV725FORTE, INC. / COMPKEY PLUSInjured EmployeeDenial Of Claim; Medical NecessityNoInformation Furnished2012-05-21T00:00:002013-04-01T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Company53636WC Healthcare Provider NtwkOrganizationINDV726HUMANA INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoClaim2012-06-19T00:00:002012-09-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORGMULTIPLE INSUREDS727GROUP & PENSION ADMINISTRATORS, INC.ProviderDelays (Claims Handling)NoNo Jurisdiction2012-06-11T00:00:002012-07-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured32390Ins Co - Licensed/ActiveOrganizationORG728CAPITOL COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Payment Expected; Information Furnished2012-06-22T00:00:002012-08-14T00:00:00Property and CasualtyHomeownersMobile Homeowner2992Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation729HUMANA INSURANCE COMPANYPhysicianCust Service Claim HandlingYesCorrective Action Taken; Information Furnished2012-06-22T00:00:002012-08-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation730STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Claim Settled; Additional Monies Received2012-06-26T00:00:002012-07-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; HAIL731HUMANA INSURANCE COMPANYRelativePremium NoticeNoRate Problem Resolved2012-06-12T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationINDV2012 NORTH TEXAS TORNADOES732OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredAgent HandlingNoInformation Furnished2012-06-15T00:00:002012-08-17T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Person; Insured1823Ins Co - Licensed/ActiveOrganizationINDV732ALI, AFZAL MInsuredOtherNoAdditional Monies Received; Information Furnished2012-06-15T00:00:002012-08-17T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Person; Insured207350AgentIndividualINDV733Harvard Pilgrim Helath CareProviderDelays (Claims Handling)NoPolicy Not In Force; Information Furnished2012-06-06T00:00:002012-07-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured Company66553OtherOrganizationORG734HUMANA INSURANCE COMPANYOtherDelays (Claims Handling)YesAdditional Monies Received; Stat Pen Pd-46 To 90 Dys Late; Information Furnished2012-06-11T00:00:002012-08-08T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationORG736STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYLienholderUnsatisfactory Settle/OfferNoClaim Settled; Additional Payment Expected2012-06-27T00:00:002012-08-21T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; TOTAL LOSS737DAIRYLAND COUNTY MUTUAL INSURANCE COMPANY OF TEXASThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoClaim Settled; Company Position Upheld2012-06-18T00:00:002012-12-18T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Associated Subject Person; Insured2737Ins Co - Licensed/ActiveOrganizationINDV738ACCC INSURANCE COMPANYThird PartyDelays (Policyholder Service)NoInformation Furnished2012-06-15T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured9825Ins Co - Licensed/ActiveOrganizationINDV738SANDERSON, JUDITH MARIEThird PartyAgent HandlingNoInformation Furnished2012-06-15T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured495049AgentIndividualINDV739AETNA LIFE INSURANCE COMPANYProviderDenial Of ClaimNoInsufficient Information2012-06-13T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HGR Elected Official245Out-Of-Ntwk AnesthesiologistOrganizationINDV740STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredCancellationNoInformation Furnished; Company Position Upheld2012-06-21T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV740WONG, SEAN INGInsuredAgent HandlingNoInformation Furnished2012-06-21T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private Pass328903AgentIndividualINDV741DRIVER'S INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished; Additional Payment Expected2012-06-22T00:00:002012-08-28T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING742METROPOLITAN LIFE INSURANCE COMPANYInsuredDelays (Claims Handling)NoQuestion of Fact; Contract Language/Legal Issue2012-06-05T00:00:002013-02-08T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life13191Ins Co - Licensed/ActiveOrganizationINDV743CHARTER OAK FIRE INSURANCE COMPANY, THEThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished2012-06-28T00:00:002012-08-28T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured Company2918Ins Co - Licensed/ActiveOrganizationINDV744LOYA INSURANCE COMPANYInsuredDelays (Claims Handling)NoClaim Settled2012-06-15T00:00:002012-08-06T00:00:00Property and CasualtyAutomobileIndividual Private Pass15643Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; TOTAL LOSS745BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/Offer; Usual And CustomaryNoOther; No Jurisdiction2012-06-22T00:00:002012-08-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company10047Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation746OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredXX-Coverage QuestionNoCompany Position Upheld2012-06-22T00:00:002012-08-23T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDV747INFINITY COUNTY MUTUAL INSURANCE COMPANYConsumer (Non-Insured)Delays (Claims Handling)NoInformation Furnished; Claim Settled2012-06-15T00:00:002012-08-10T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured1197Ins Co - Licensed/ActiveOrganizationINDVSUPPLEMENTARY PAYMENT748BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-06-11T00:00:002012-07-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationORG749PHYSICIANS MUTUAL INSURANCE COMPANYInsuredPremium NoticeNoInformation Furnished2012-06-20T00:00:002012-08-02T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1787Ins Co - Licensed/ActiveOrganizationINDV750ALLSTATE TEXAS LLOYD'SOtherCust Service Claim Handling; Denial Of ClaimNoCompany Position Upheld; Information Furnished; Additional Payment Expected2012-06-22T00:00:002012-08-31T00:00:00Property and CasualtyHomeownersHomeownersInsured3721Ins Co - Licensed/ActiveOrganizationINDVROOF751METROPOLITAN LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction2012-06-26T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&H13191Self-Funded / ErisaOrganizationINDV752CIGNA HEALTHCARE OF TEXAS, INC.ProviderDenial Of ClaimYesAdditional Monies Received2012-05-21T00:00:002012-12-05T00:00:00Health Maintenance OrgAccident and HealthGroup A&HAssociated Subject Company; Insured8294Health Maintenance OrgOrganizationORG753GENERAL AMERICAN LIFE INSURANCE COMPANYInsuredPremium NoticeNoContract Language/Legal Issue2012-06-25T00:00:002012-08-30T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2502Ins Co - Licensed/ActiveOrganizationINDV754FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYAttorneyDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished2012-06-28T00:00:002012-08-27T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person2623Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING755STATE FARM LLOYDSInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Company Position Upheld; Information Furnished2012-06-15T00:00:002013-01-23T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE; HAIL; ROOF756BROUSSARD, MICHAEL EUGENEInsuredAgent HandlingNoInformation Furnished2012-06-28T00:00:002012-08-22T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines116138AgentIndividualINDV757TEXAS FARMERS INSURANCE COMPANYInsuredCust Service Claim Handling; DisasterNoAdditional Monies Received; Information Furnished2012-06-27T00:00:002012-08-02T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent1452Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE758GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoQuestion of Fact2012-06-23T00:00:002012-08-06T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVCOMPARATIVE NEGLIGENCE; GR-Claim Evaluation759REASSURE AMERICA LIFE INSURANCE COMPANYInsuredCust Service Claim Handling; Denial Of ClaimNoInformation Furnished; Additional Monies Received2012-06-26T00:00:002012-08-13T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1228Ins Co - Licensed/ActiveOrganizationINDVCANCER760SAFEGUARD HEALTH PLANS, INC.InsuredFraudNoInformation Furnished2012-06-06T00:00:002012-07-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person3729Health Maintenance OrgOrganizationINDV761INFINITY COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled; Information Furnished2012-06-18T00:00:002012-08-29T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company1197Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; SUPPLEMENTARY PAYMENT762INDEPENDENCE TITLE COMPANYThird PartyXX-State SpecificNoCompany Position Upheld2012-06-28T00:00:002012-09-19T00:00:00Property and CasualtyMiscellaneousTitle Insurance66531AgentOrganizationINDV763BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONOtherDelays (Claims Handling)YesClaim Not Clean2012-06-11T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationORG764WAUSAU UNDERWRITERS INSURANCE COMPANYAttorneyDelays (Claims Handling)NoInformation Furnished; Company Position Upheld2012-06-21T00:00:002012-09-06T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1041Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING765ARCH INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-06-25T00:00:002012-08-27T00:00:00Property and CasualtyAutomobileTruckers PolicyAssociated Subject Company; Associated Subject Person; Insured Company625Ins Co - Licensed/ActiveOrganizationORGCOVERAGE DISPUTE766MEDCO HEALTH, L.L.C.InsuredDenial Of ClaimNoNo Jurisdiction2012-06-20T00:00:002012-09-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&H54629Ins Co - Licensed/ActiveOrganizationINDV767UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDenial Of ClaimYesAdditional Monies Received2012-04-20T00:00:002012-07-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG768BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONHospitalDelays (Claims Handling)YesClean Claims Violation; Additional Monies Received; Additional Payment Expected2012-06-22T00:00:002012-09-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation770MOLINA HEALTHCARE OF TEXAS, INC.PhysicianDelays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-06-01T00:00:002012-08-17T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured23469Ins Co - Licensed/ActiveOrganizationINDV771UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received2012-06-11T00:00:002012-07-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationORG772CONNECTICUT GENERAL LIFE INSURANCE COMPANYRelativeDenial Of ClaimNoNo Jurisdiction2012-06-15T00:00:002012-08-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationINDVEXPERIMENTAL/INVESTIGATIONAL773HOCHHEIM PRAIRIE FARM MUTUAL INSURANCE ASSOCIATIONInsuredDenial Of ClaimYesInformation Furnished; Claim Settled2012-06-21T00:00:002012-08-17T00:00:00Property and CasualtyHomeownersHomeowners2350Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE773ROBERSON, SHARON HENDONInsuredCust Service Claim HandlingYes2012-06-21T00:00:002012-08-17T00:00:00Property and CasualtyHomeownersHomeowners81336AgentIndividualINDVCOVERAGE DISPUTE774HEARTLAND NATIONAL LIFE INSURANCE COMPANYInsuredRefund Of PremiumNoInformation Furnished2012-06-25T00:00:002012-08-29T00:00:00Medicare Managed Care for HMOAccident and HealthIndividual A & HAssociated Subject Company2762Ins Co - Licensed/ActiveOrganizationINDV774SILLERS, DIANE SUEInsuredAgent/Agency Contrct TerminNoInformation Furnished2012-06-25T00:00:002012-08-29T00:00:00Medicare Managed Care for HMOAccident and HealthIndividual A & HAssociated Subject Company833036AgentIndividualINDV775ALLSTATE INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Payment Expected; Company Position Upheld; Information Furnished2012-06-25T00:00:002012-08-28T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person168Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation776HOME STATE COUNTY MUTUAL INSURANCE COMPANYOtherUnsatisfactory Settle/OfferNoQuestion of Fact2012-06-25T00:00:002012-08-06T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured2362Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE776Johnson, RonOtherCust Service Claim Handling; Unsatisfactory Settle/OfferNoQuestion of Fact2012-06-25T00:00:002012-08-06T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1129034Claims AdjusterIndividualINDVADJUSTER'S HANDLING; DAMAGE DISPUTE777PRUDENTIAL INSURANCE COMPANY OF AMERICA, THEInsuredDenial Of Claim; Pre-Existing ConditionNoInformation Furnished2012-06-06T00:00:002012-08-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1729Ins Co - Licensed/ActiveOrganizationINDV778COMPANION INSURANCE COMPANYInsuredCancellationNoCancel/Non-Renewal Upheld; Information Furnished2012-05-24T00:00:002012-07-31T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company2841Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE780BRAHMA TITLE AND ESCROW LLCInsuredOtherYesPolicy Issued/Restored2012-06-21T00:00:002012-08-28T00:00:00Property and CasualtyMiscellaneousTitle Insurance66568AgentOrganizationINDV781HUMANA HEALTH PLAN OF TEXAS, INC.ProviderRecoupment Of Claims PaymentNoInformation Furnished; Additional Monies Received; No Jurisdiction2012-06-20T00:00:002012-10-23T00:00:00Medicare HMOAccident and HealthGroup A&HInsured702Health Maintenance OrgOrganizationORG782LOYA INSURANCE COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld2012-06-18T00:00:002012-08-31T00:00:00Property and CasualtyAutomobileIndividual Private PassGR Elected Official15643Ins Co - Licensed/ActiveOrganizationINDVDRIVER NOT COVERED; POLICY EXCLUSION783HUMANA HEALTH PLAN OF TEXAS, INC.ProviderDenial Of Claim; Medical NecessityYesInformation Furnished2012-05-06T00:00:002012-09-19T00:00:00Utilization Review AgentAccident and HealthGroup A&HAssociated Subject Company; Insured702Health Maintenance OrgOrganizationORG784SAN ANTONIO INDEMNITY COMPANYInsuredNon-RenewalNoInformation Furnished; Claim Settled2012-06-28T00:00:002012-12-17T00:00:00Property and CasualtyHomeownersHomeowners975Ins Co - Licensed/ActiveOrganizationINDV784PRONTO GENERAL AGENCY, LTD.InsuredNon-RenewalNoClaim Settled2012-06-28T00:00:002012-12-17T00:00:00Property and CasualtyHomeownersHomeowners27896Ins Co - Licensed/ActiveOrganizationINDV784KINNARD, ROBERT EUGENEInsuredAgent HandlingYesInformation Furnished2012-06-28T00:00:002012-12-17T00:00:00Property and CasualtyHomeownersHomeowners69580AgentIndividualINDV785OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)YesClaim Settled; Information Furnished2012-06-21T00:00:002012-08-22T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; UNCOOPERATIVE INSURED786UNITRIN COUNTY MUTUAL INSURANCE COMPANYInsuredOther; Premium NoticeNoCompany Position Upheld2012-06-25T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass1856Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA786STRACK, LAURA ELIZABETHInsuredAgent HandlingNoInformation Furnished2012-06-25T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass246564Claims AdjusterIndividualINDVUNDERWRITING CRITERIA787ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received; Claim Settled2012-06-28T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; LOSS OF USE788OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYAttorneyDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished2012-06-27T00:00:002012-07-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Person; Correspondent Person; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; GR-Claim Evaluation; LOSS OF USE; TOTAL LOSS789PHYSICIANS HEALTH CHOICE OF TEXAS, LLCHospitalMedical NecessityNoNo Jurisdiction; Information Furnished2012-06-27T00:00:002012-10-23T00:00:00Medicare HMOAccident and HealthGroup A&HCorrespondent Company; Correspondent Person; Insured17170Health Maintenance OrgOrganizationORGPRESCRIPTION790GERMANIA FARM MUTUAL INSURANCE ASSOCIATIONConsumer (Non-Insured)Refusal to InsureNoCompany Position Upheld; Information Furnished2012-06-28T00:00:002012-09-17T00:00:00Property and CasualtyHomeownersFarmowner / Ranchowner2468Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA791MARKEL INSURANCE COMPANYProviderDelays (Claims Handling); SB418 Rule ViolationYesAdditional Monies Received; Clean Claims Violation; Stat Pen Pd-Over 90 Dys Late2012-06-11T00:00:002012-08-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&H660Ins Co - Licensed/ActiveOrganizationORG791HAMMERMAN & GAINER, INC.ProviderDelays (Claims Handling)NoInformation Furnished2012-06-11T00:00:002012-08-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&H29285Third Party AdministratorsOrganizationORG792OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInsufficient Information2012-06-18T00:00:002012-11-20T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVLOSS OF USE793AMERICAN STRATEGIC INSURANCE CORP.InsuredNon-RenewalNoInformation Furnished; Contract Language/Legal Issue2012-06-21T00:00:002012-09-04T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency53094Ins Co - Licensed/ActiveOrganizationINDV794SOBERS, ANSON VINCENTInsuredAgent HandlingNoNo Jurisdiction2012-06-04T00:00:002012-10-02T00:00:00Life, Accident and HealthMiscellaneousNo Line SpecifiedAssociated Subject Company469818AgentIndividualINDV796MONUMENTAL LIFE INSURANCE COMPANYInsuredRefund Of PremiumNoContract Language/Legal Issue; Information Furnished2012-06-13T00:00:002012-07-31T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2010Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN798UNITRIN COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled; Information Furnished2012-06-21T00:00:002012-08-13T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1856Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation799TRAVELERS HOME AND MARINE INSURANCE COMPANY, THEInsuredUnsatisfactory Settle/OfferNoAdditional Monies Received2012-06-28T00:00:002012-08-15T00:00:00Property and CasualtyHomeownersHomeowners3875Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; ROOF800ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICAInsuredPremium and RatingNoInformation Furnished; Contract Language/Legal Issue2012-06-22T00:00:002012-07-24T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities910Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN801AETNA LIFE INSURANCE COMPANYBeneficiaryDelays (Claims Handling)NoNo Jurisdiction; Information Furnished2012-06-20T00:00:002012-08-08T00:00:00Life, Accident and HealthLife & AnnuityGroup Life245Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation802LIFE INSURANCE COMPANY OF NORTH AMERICAInsuredDenial Of ClaimNoCompany Position Upheld2012-06-13T00:00:002012-07-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2157Ins Co - Licensed/ActiveOrganizationINDV803STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYProviderDelays (Claims Handling)NoContract Language/Legal Issue; Information Furnished; Additional Payment Expected2012-06-18T00:00:002012-08-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationORG804UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished2012-06-19T00:00:002012-09-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGMULTIPLE INSUREDS805OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld2012-06-26T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation805MARTINEZ, IGNACIO HERNANDEZInsuredAgent HandlingNoInformation Furnished2012-06-26T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency115271AgentIndividualINDVCOVERAGE DISPUTE; GR-Claim Evaluation806BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferNoContract Language/Legal Issue2012-06-25T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation807LIBERTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled; Information Furnished2012-06-21T00:00:002012-08-13T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2209Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING808ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue2012-06-18T00:00:002012-07-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation809SUPERIOR HEALTHPLAN, INC.ProviderDelays (Claims Handling); Denial Of ClaimNoNo Jurisdiction; Information Furnished2012-06-01T00:00:002012-09-24T00:00:00Children Health Insurance PlanAccident and HealthGroup A&HCorrespondent Person; Insured10198Ins Co - Licensed/ActiveOrganizationORG810DRIVER'S INSURANCE COMPANYInsuredCust Service Claim Handling; Liability Dispute; Unsatisfactory Settle/OfferYesInformation Furnished; Additional Monies Received2012-06-15T00:00:002012-08-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation811HEALTH NET OF CALIFORNIA, INC.HospitalDenial Of ClaimNoInsufficient Information2012-04-20T00:00:002012-08-06T00:00:00Utilization Review AgentAccident and HealthGroup A&HAssociated Subject Company; Correspondent Person; Insured66575Ins Co - Licensed/ActiveOrganizationORG812DELTA DENTAL INSURANCE COMPANYProviderDenial Of ClaimNoAdditional Monies Received; Information Furnished2012-06-22T00:00:002012-08-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured2752Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation813UNITRIN SAFEGUARD INSURANCE COMPANYInsuredDenial Of Claim; Unsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished; Question of Fact2012-06-21T00:00:002012-08-22T00:00:00Property and CasualtyHomeownersHomeowners26930Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF; WATER DAMAGE815JACKSON NATIONAL LIFE INSURANCE COMPANYOtherDelays (Policyholder Service)NoInformation Furnished2012-06-11T00:00:002012-08-01T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities3718Ins Co - Licensed/ActiveOrganizationORG816PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received; Claim Settled2012-06-15T00:00:002012-08-10T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1708Ins Co - Licensed/ActiveOrganizationINDVCHIROPRACTIC; GR-Claim Evaluation817AETNA LIFE INSURANCE COMPANYPhysicianUnsatisfactory Settle/OfferNoNo Jurisdiction2012-06-25T00:00:002012-07-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation818NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA.InsuredRefund Of PremiumNoPremium Refunded; Additional Monies Received2012-06-21T00:00:002012-12-06T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Insured1931Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA819ESTES ROOFINGOtherMisrepresentationNoInsufficient Information2012-06-13T00:00:002012-10-01T00:00:00Property and CasualtyHomeownersHomeowners73524OtherOrganizationINDVROOF821ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoClaim Settled2012-06-28T00:00:002012-08-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation822UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-06-06T00:00:002012-07-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationORGBUNDLING823BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredRefund Of PremiumNoContract Language/Legal Issue2012-06-19T00:00:002012-07-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV824LINCOLN NATIONAL LIFE INSURANCE COMPANY, THEInsuredDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-06-18T00:00:002012-09-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2172Ins Co - Licensed/ActiveOrganizationINDV825USAA GENERAL INDEMNITY COMPANYThird PartyLiability Dispute; Unsatisfactory Settle/OfferNoQuestion of Fact2012-06-15T00:00:002012-08-16T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1276Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COMPARATIVE NEGLIGENCE; DAMAGE DISPUTE; GR-Claim Evaluation829GUARDIAN LIFE INSURANCE COMPANY OF AMERICA, THEProviderRecoupment Of Claims PaymentNoNo Jurisdiction; Information Furnished2012-06-22T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2414Ins Co - Licensed/ActiveOrganizationORG830UNITED TEACHER ASSOCIATES INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished2012-06-25T00:00:002012-08-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured3486Ins Co - Licensed/ActiveOrganizationINDV831CONSUMERS COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeNoCompany Position Upheld; Information Furnished2012-06-15T00:00:002012-07-30T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2806Ins Co - Licensed/ActiveOrganizationINDV832OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld; Insufficient Information; Policy Not In Force2012-06-21T00:00:002012-08-22T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Associated Subject Person; Insured1823Ins Co - Licensed/ActiveOrganizationINDV833Excel Title GroupOtherDelays (Claims Handling)YesAdditional Monies Received2012-06-20T00:00:002012-08-31T00:00:00Property and CasualtyMiscellaneousTitle Insurance66586AgentOrganizationORG834Annuity.comInsurance CompanyMisleading AdvertisingYesOther; Advertising Withdrawn/Amended2012-06-15T00:00:002012-09-14T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesAssociated Agent66587OtherOrganizationORGADVERTISING835OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; Company Position Upheld2012-06-18T00:00:002012-08-08T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Person; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; NAMED DRIVER POLICY; UNCOOPERATIVE INSURED836OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoInformation Furnished2012-06-15T00:00:002012-08-06T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING837MCNA DENTALPhysicianDenial Of ClaimNoAdditional Monies Received2012-05-02T00:00:002012-07-31T00:00:00Children Health Insurance PlanAccident and HealthGroup A&HAssociated Subject Company; Insured66589Health Maintenance OrgOrganizationINDV838LIFE INSURANCE COMPANY OF NORTH AMERICAInsuredDenial Of ClaimNoAdditional Payment Expected; Information Furnished; Contract Language/Legal Issue2012-06-11T00:00:002012-07-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2157Ins Co - Licensed/ActiveOrganizationINDV839STATE LIFE INSURANCE COMPANY, THERelativeDelays (Claims Handling)YesAdditional Monies Received; Additional Payment Expected2012-06-26T00:00:002012-07-17T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesDeceased Person1511Ins Co - Licensed/ActiveOrganizationINDV840UNITEDHEALTHCARE INSURANCE COMPANYRelativeUnsatisfactory Settle/OfferYesInformation Furnished; Additional Monies Received2012-06-18T00:00:002012-07-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV841CENTERPOINT ENERGYThird PartyClosed-Lack Of Info Cmplainant; Delays (Policyholder Service)NoInsufficient Information2012-06-21T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileBusiness Automobile24661OtherOrganizationINDV842BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoNo Jurisdiction2012-06-21T00:00:002012-07-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Insurance AgencyOrganizationORG843STONEBRIDGE LIFE INSURANCE COMPANYBeneficiaryDelays (Claims Handling)NoAdditional Payment Expected2012-06-18T00:00:002012-07-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured2269Ins Co - Licensed/ActiveOrganizationINDV844GOLDEN RULE INSURANCE COMPANYInsuredDenial Of Claim; Lifetime/Annual LimitsNoInformation Furnished; Contract Language/Legal Issue2012-06-19T00:00:002012-07-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1057Ins Co - Licensed/ActiveOrganizationINDV845TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoAppraisal Process Invoked; Information Furnished; Additional Monies Received2012-06-01T00:00:002012-07-31T00:00:00Property and CasualtyHomeownersHomeownersGR Elected Official1450Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; DEPRECIATION; GR-Claim Evaluation; WATER DAMAGE846TEXAS WINDSTORM INSURANCE ASSOCIATIONRelativeIncreased Dwelling Coverage; Premium Notice; Refund Of PremiumNoPremium Refunded; Cancel/Non-Renewal Upheld; Information Furnished2012-06-18T00:00:002012-10-10T00:00:00Property and CasualtyHomeownersHomeowners1444Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNDERWRITING CRITERIA846PALOMO, DAVID ALBERTRelativeDelays (Policyholder Service); Premium NoticeYesInformation Furnished; Corrective Action Taken2012-06-18T00:00:002012-10-10T00:00:00Property and CasualtyHomeownersHomeowners1129137AgentIndividualINDVCOVERAGE DISPUTE; UNDERWRITING CRITERIA847LIFE INSURANCE COMPANY OF NORTH AMERICAInsuredDenial Of ClaimNoInformation Furnished; No Jurisdiction2012-06-11T00:00:002012-08-08T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2157Ins Co - Licensed/ActiveOrganizationINDV848HARTFORD INSURANCE COMPANY OF THE MIDWESTOtherNot Within TDI JurisdictionNoNo Jurisdiction2012-06-21T00:00:002013-01-28T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines650Ins Co - Licensed/ActiveOrganizationORG848TEXAS MUTUAL INSURANCE COMPANYOtherNot Within TDI JurisdictionNoNo Jurisdiction2012-06-21T00:00:002013-01-28T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines3500Ins Co - Licensed/ActiveOrganizationORG848BKCW L POtherNot Within TDI JurisdictionNoNo Jurisdiction2012-06-21T00:00:002013-01-28T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines6237AgentOrganizationORG848ESSEX INSURANCE COMPANYOtherNot Within TDI JurisdictionNoNo Jurisdiction2012-06-21T00:00:002013-01-28T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines51989Ins Co - Licensed/ActiveOrganizationORG848Williams Tunneling Industries, Inc.OtherNot Within TDI JurisdictionYesNo Jurisdiction2012-06-21T00:00:002013-01-28T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines73988OtherOrganizationORG849USAA CASUALTY INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished2012-06-18T00:00:002012-07-30T00:00:00Property and CasualtyHomeownersRental3607Ins Co - Licensed/ActiveOrganizationINDV850PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; Company Position Upheld2012-06-15T00:00:002012-08-16T00:00:00Property and CasualtyAutomobileBusiness Automobile1708Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation851BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONNon-Contracted ProviderDelays (Claims Handling)NoCompany Position Upheld; Claim Not Clean; Additional Monies Received2012-06-19T00:00:002012-07-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG852AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoInformation Furnished; No Jurisdiction2012-06-26T00:00:002012-08-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV853STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredDelays (Claims Handling)NoAdditional Monies Received; Additional Payment Expected; Claim Settled2012-06-08T00:00:002012-07-23T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVACV; ADJUSTER'S HANDLING; BURDEN OF PROOF; DEDUCTIBLE; GR-Claim Evaluation; LOSS OF USE; REPLACEMENT VEHICLE; TOTAL LOSS854AETNA LIFE INSURANCE COMPANYInsuredDelays (Policyholder Service)NoOther2012-06-11T00:00:002012-08-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV855MOLINA HEALTHCARE OF TEXAS, INC.PhysicianDelays (Claims Handling)NoNo Jurisdiction2012-06-15T00:00:002012-08-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person; Insured23469Health Maintenance OrgOrganizationINDV856GENERAL INSURANCE COMPANY OF AMERICAThird PartyDelays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-06-28T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2508Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; LOSS OF USE; REPLACEMENT VEHICLE857LAFAYETTE LIFE INSURANCE COMPANY, THEInsuredRefund Of PremiumNoAdditional Monies Received2012-06-22T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2188Ins Co - Licensed/ActiveOrganizationINDV857HUTSON, CLINTON HOWARDInsuredAgent Handling; MisrepresentationNoContract Language/Legal Issue2012-06-22T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life472699AgentIndividualINDV857THWEATT, RICHARD TODDInsuredAgent Handling; MisrepresentationNoContract Language/Legal Issue2012-06-22T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life669255AgentIndividualINDV859OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYAttorneyDelays (Claims Handling)NoAdditional Payment Expected; Information Furnished; Company Position Upheld2012-06-15T00:00:002012-08-15T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Associated Subject Person; Correspondent Person; Insured1823Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; GR-Claim Evaluation; UNCOOPERATIVE INSURED860STATE FARM LLOYDSInsuredCancellation; Delays (Claims Handling); Denial Of ClaimNoCancellation Withdrawn; Claim Settled2012-06-21T00:00:002012-08-17T00:00:00Property and CasualtyHomeownersRental3105Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; UNDERWRITING CRITERIA861AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-06-21T00:00:002012-07-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation862TEXAS MUTUAL INSURANCE COMPANYProviderCoordination of BenefitsNoRecord Only2012-06-20T00:00:002013-03-08T00:00:00Workers' CompensationMiscellaneousWorkers' Compensation3500Ins Co - Licensed/ActiveOrganizationORG863STANDARD INSURANCE COMPANYRelativeUnsatisfactory Settle/OfferNoPremium Refunded; Contract Language/Legal Issue; Information Furnished2012-06-18T00:00:002012-07-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured582Ins Co - Licensed/ActiveOrganizationINDV864USAA LIFE INSURANCE COMPANYInsuredOtherNoInformation Furnished; Policy Issued/Restored2012-06-06T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1277Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN865SUPERIOR HEALTHPLAN, INC.PhysicianDelays (Claims Handling)NoInformation Furnished; No Jurisdiction2012-06-15T00:00:002012-08-06T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person10198Health Maintenance OrgOrganizationINDV866NATIONWIDE MUTUAL INSURANCE COMPANYOtherMisrepresentationNoOther2012-06-28T00:00:002012-09-11T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent1937Ins Co - Licensed/ActiveOrganizationINDV866BARHORST INSURANCE GROUPOtherMisrepresentationYesOther2012-06-28T00:00:002012-09-11T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent33611Insurance AgencyOrganizationINDV868GOLDEN RULE INSURANCE COMPANYInsuredPremium and RatingYesInformation Furnished2012-06-21T00:00:002012-07-18T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1057ProviderOrganizationINDV870TEXAS MUTUAL INSURANCE COMPANYNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-06-19T00:00:002012-10-19T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Company; Correspondent Person; Insured3500Ins Co - Licensed/ActiveOrganizationORG870TEXAS STAR NETWORK/COVENTRYNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-06-19T00:00:002012-10-19T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Company; Correspondent Person; Insured55311WC Healthcare Provider NtwkOrganizationORG871NATIONAL INTERSTATE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished2012-06-18T00:00:002012-07-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass3548Ins Co - Licensed/ActiveOrganizationINDVACV; ADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation872MEGA LIFE AND HEALTH INSURANCE COMPANY, THEPhysicianUnsatisfactory Settle/Offer; XX-RecoupmentNoInformation Furnished; Overpaid Claim Recouped2012-06-22T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2120Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation873ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICAInsuredMisrepresentationNoContract Language/Legal Issue; Information Furnished2012-06-18T00:00:002012-07-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life910Ins Co - Licensed/ActiveOrganizationINDV874Stewart Title CompanyConsumer (Non-Insured)XX-State SpecificNoCompany Position Upheld2012-06-22T00:00:002012-08-17T00:00:00Property and CasualtyMiscellaneousTitle Insurance66600AgentOrganizationINDV875WASHINGTON NATIONAL INSURANCE COMPANYInsuredCancellationNoCancellation Withdrawn; Policy Issued/Restored2012-06-06T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1196Ins Co - Licensed/ActiveOrganizationINDV875BREWSTER, JEREMY TRAVISInsuredAgent Handling; MisrepresentationYesInformation Furnished2012-06-06T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H885983AgentIndividualINDV875GUILFOILE, STEVEN WILLIAMInsuredAgent Handling; MisrepresentationYesInformation Furnished2012-06-06T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1101948AgentIndividualINDV876STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferYesInformation Furnished; Additional Payment Expected2012-06-15T00:00:002012-07-26T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING877SUPERIOR HEALTHPLAN, INC.ProviderDelays (Claims Handling)NoAdditional Payment Expected2012-06-18T00:00:002012-12-12T00:00:00Health Maintenance OrgAccident and HealthGroup A&H10198Health Maintenance OrgOrganizationORG878VIKING INSURANCE COMPANY OF WISCONSINThird PartyDelays (Claims Handling)NoNo Jurisdiction2012-05-17T00:00:002012-07-23T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company1055Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; DRIVER NOT COVERED; POLICY EXCLUSION; UNDERWRITING CRITERIA879TEXAS MUTUAL INSURANCE COMPANYNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-06-20T00:00:002012-10-19T00:00:00Workers Compensation NetworkMiscellaneousWorkers' CompensationAssociated Subject Company; Correspondent Person; Insured3500Ins Co - Licensed/ActiveOrganizationORG880SANTA FE AUTO INSURANCE COMPANYAttorneyDenial Of ClaimNoContract Language/Legal Issue2012-05-28T00:00:002012-07-11T00:00:00Property and CasualtyAutomobileIndividual Private Pass27766Ins Co - Licensed/ActiveOrganizationINDV881OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Liability DisputeNoInformation Furnished; Company Position Upheld2012-06-28T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private PassAlias Name; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; LOSS OF USE; UNCOOPERATIVE INSURED882LOYA INSURANCE COMPANYInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-06-21T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass15643Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; DAMAGE DISPUTE; GR-Claim Evaluation883ALLIED PROPERTY AND CASUALTY INSURANCE COMPANYInsuredCancellationNoCancel/Non-Renewal Upheld; Information Furnished; Company Position Upheld2012-06-06T00:00:002012-07-19T00:00:00Property and CasualtyHomeownersHomeowners3350Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNDERWRITING CRITERIA884UNITED SERVICES AUTOMOBILE ASSOCIATIONInsuredDelays (Claims Handling)YesClaim Settled2012-06-18T00:00:002012-07-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass1254Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation885STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredDelays (Claims Handling)NoClaim Settled; Information Furnished2012-06-15T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation886CHICAGO TITLE INSURANCE COMPANYAttorneyDenial Of ClaimNoQuestion of Fact2012-06-07T00:00:002012-08-26T00:00:00Property and CasualtyMiscellaneousTitle Insurance51988Ins Co - Licensed/ActiveOrganizationINDV887AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/Offer; XX-RecoupmentNoNo Jurisdiction2012-06-21T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG888BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoInformation Furnished; Additional Payment Expected2012-06-19T00:00:002012-08-02T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life10047Ins Co - Licensed/ActiveOrganizationINDV889PHYSICIANS HEALTH CHOICE OF TEXAS, LLCHospitalDelays (Claims Handling)NoInformation Furnished; No Jurisdiction2012-06-04T00:00:002012-09-20T00:00:00Medicare HMOAccident and HealthGroup A&HCorrespondent Company; Correspondent Person; Insured17170Health Maintenance OrgOrganizationORG889WELLMED MEDICAL MANAGEMENT, INC.HospitalDelays (Claims Handling)NoOther2012-06-04T00:00:002012-09-20T00:00:00Medicare HMOAccident and HealthGroup A&HCorrespondent Company; Correspondent Person; Insured44123Ins Co - Licensed/ActiveOrganizationORG890BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-06-21T00:00:002012-08-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV891AAA TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Policyholder Service)NoInformation Furnished2012-06-11T00:00:002012-08-14T00:00:00Property and CasualtyAutomobileIndividual Private Pass2286Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA892ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; Additional Payment Expected2012-06-21T00:00:002012-08-10T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured9825Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING893CONSECO LIFE INSURANCE COMPANYInsuredDelays (Policyholder Service)NoInformation Furnished2012-06-18T00:00:002012-08-03T00:00:00Life, Accident and HealthLife & AnnuityGroup Life2113Ins Co - Licensed/ActiveOrganizationINDV894HUMANADENTAL INSURANCE COMPANYInsuredMisrepresentation; Refund Of PremiumYesPremium Refunded2012-06-22T00:00:002012-07-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1182Ins Co - Licensed/ActiveOrganizationINDV895ALLSTATE INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld; Policy Not In Force; Information Furnished2012-06-15T00:00:002012-08-17T00:00:00Property and CasualtyHomeownersHomeowners168Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; ROOF896TRANSAMERICA LIFE INSURANCE COMPANYInsuredCash ValueNoAdditional Payment Expected; Contract Language/Legal Issue2012-06-19T00:00:002012-07-18T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1983Ins Co - Licensed/ActiveOrganizationINDV897STATE FARM LLOYDSInsuredDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-06-28T00:00:002012-09-13T00:00:00Property and CasualtyHomeownersRental3105Ins Co - Licensed/ActiveOrganizationINDVWATER DAMAGE898TRAVELERS LLOYDS OF TEXAS INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished2012-06-19T00:00:002012-08-15T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person776Ins Co - Licensed/ActiveOrganizationINDV899HUMANA INSURANCE COMPANYProviderMedical NecessityNoClaim Settled; Additional Monies Received2012-06-21T00:00:002012-08-08T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation900AETNA HEALTH INC.InsuredDelays In AuthorizationNoCorrective Action Taken2012-06-18T00:00:002012-07-17T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured3522Ins Co - Licensed/ActiveOrganizationINDV901PARKLAND COMMUNITY HEALTH PLAN, INC., A PROGRAM OF DALLAS COUNTY HOSPITAL DISTRICTProviderDelays (Claims Handling)YesInformation Furnished; Additional Monies Received2012-06-21T00:00:002012-10-11T00:00:00Children Health Insurance PlanAccident and HealthIndividual A & HCorrespondent Person; Insured; Third Party Admin-Licensed8254Health Maintenance OrgOrganizationORG902HOMEOWNERS OF AMERICA INSURANCE COMPANYInsuredPost-Claim UnderwritingNoInformation Furnished2012-06-18T00:00:002012-09-12T00:00:00Property and CasualtyHomeownersHomeowners25247Ins Co - Licensed/ActiveOrganizationINDVWATER DAMAGE903UNITEDHEALTHCARE OF TEXAS, INC.InsuredUnsatisfactory Settle/OfferNoInformation Furnished2012-06-18T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured3363Health Maintenance OrgOrganizationINDV904UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDenial Of ClaimNoNo Jurisdiction2012-06-25T00:00:002012-07-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation905Lawyers Title CompanyConsumer (Non-Insured)Delays (Claims Handling)NoCompany Position Upheld2012-06-11T00:00:002012-09-19T00:00:00Property and CasualtyMiscellaneousTitle Insurance66608AgentOrganizationORG907PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYProviderDelays (Claims Handling)YesClaim Settled2012-06-18T00:00:002012-08-27T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1708Ins Co - Licensed/ActiveOrganizationORGCHIROPRACTIC; GR-Claim Evaluation908SCOTT AND WHITE HEALTH PLANInsuredCust Service Claim Handling; OverchargesYesInformation Furnished; Corrective Action Taken2012-06-21T00:00:002012-10-02T00:00:00Health Maintenance OrgAccident and HealthGroup A&H788Health Maintenance OrgOrganizationINDV909UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished2012-06-19T00:00:002012-08-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGBUNDLING910UNITED SERVICES AUTOMOBILE ASSOCIATIONThird PartyUnsatisfactory Settle/OfferNoAdditional Monies Received; Question of Fact2012-06-21T00:00:002012-08-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass1254Ins Co - Licensed/ActiveOrganizationINDVACV; GR-Claim Evaluation; TOTAL LOSS911HUMANA HEALTH PLAN OF TEXAS, INC.ProviderDenial Of ClaimNoAdditional Monies Received2012-06-21T00:00:002012-09-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured702Health Maintenance OrgOrganizationORGGR-Claim Evaluation912TEXAS MUTUAL INSURANCE COMPANYNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-06-19T00:00:002012-10-19T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkCorrespondent Person; Insured3500Ins Co - Licensed/ActiveOrganizationORG912TEXAS STAR NETWORK/COVENTRYNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-06-19T00:00:002012-10-19T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkCorrespondent Person; Insured55311WC Healthcare Provider NtwkOrganizationORG913BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld2012-06-25T00:00:002012-07-25T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured10047Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation914TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredRefund Of PremiumNoCompany Position Upheld2012-05-29T00:00:002012-08-10T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company1444Ins Co - Licensed/ActiveOrganizationINDV914FIRE INSURANCE EXCHANGEInsuredRefund Of PremiumNoCompany Position Upheld2012-05-29T00:00:002012-08-10T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company2606Ins Co - Licensed/ActiveOrganizationINDV914KIMBRO, JOHN MICHAEL JRInsuredRefund Of PremiumYesAdditional Monies Received2012-05-29T00:00:002012-08-10T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company814627AgentIndividualINDV915STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDelays (Claims Handling)YesAdditional Payment Expected; Information Furnished2012-06-12T00:00:002012-08-28T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation916DEARBORN NATIONAL LIFE INSURANCE COMPANYBeneficiaryDenial Of ClaimNoNo Jurisdiction2012-06-21T00:00:002012-07-25T00:00:00Life, Accident and HealthLife & AnnuityGroup LifeInsured1013Ins Co - Licensed/ActiveOrganizationINDV917HOME STATE COUNTY MUTUAL INSURANCE COMPANYLienholderDelays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld2012-06-21T00:00:002012-08-23T00:00:00Property and CasualtyAutomobileIndividual Private Pass2362Ins Co - Licensed/ActiveOrganizationORGACV; TOTAL LOSS918CINCINNATI INSURANCE COMPANY, THEThird PartyUnsatisfactory Settle/OfferYesClaim Settled; Additional Payment Expected2012-06-18T00:00:002012-07-31T00:00:00Property and CasualtyLiabilityGeneral LiabilityInsured2878Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation919ALFA SPECIALTY INSURANCE CORPORATIONThird PartyUnsatisfactory Settle/OfferYesAdditional Payment Expected; Information Furnished; Company Position Upheld2012-06-15T00:00:002012-08-24T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured29802Ins Co - Licensed/ActiveOrganizationINDVACV; GR-Claim Evaluation; TOTAL LOSS920TIME INSURANCE COMPANYProviderSB418 Rule ViolationYesClean Claims Violation; Additional Monies Received; Stat Pen Pd-Over 90 Dys Late2012-06-21T00:00:002012-08-20T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured1374Ins Co - Licensed/ActiveOrganizationORG921PRUDENTIAL INSURANCE COMPANY OF AMERICA, THEInsuredPremium and RatingNoInformation Furnished; Contract Language/Legal Issue2012-06-18T00:00:002012-07-23T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1729Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN922VALIC RETIREMENT SERVICES COMPANYInsuredMisrepresentationNoNo Jurisdiction2012-06-21T00:00:002012-11-07T00:00:00Life, Accident and HealthLife & AnnuityIRA 55488Financial InstitutionOrganizationINDV923TEXAS MUTUAL INSURANCE COMPANYNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-06-22T00:00:002012-10-19T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Company; Correspondent Person; Insured3500WC Healthcare Provider NtwkOrganizationORGGR-Claim Evaluation924QUANTUM CAPITAL INVESTMENTInsuredOtherYesFailure to Timely Respond2012-06-08T00:00:002012-10-05T00:00:00Property and CasualtyHomeownersHomeowners67291Mortgage LenderOrganizationINDV925MONUMENTAL LIFE INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished; Contract Language/Legal Issue2012-06-21T00:00:002012-08-29T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured2010Ins Co - Licensed/ActiveOrganizationINDV926TEXAS FARMERS INSURANCE COMPANYInsuredDelays (Policyholder Service)NoInformation Furnished2012-06-20T00:00:002012-09-10T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDV927TRAVELERS INDEMNITY COMPANY, THEInsuredNon-Renewal; Premium and RatingYesInformation Furnished2012-06-11T00:00:002012-08-06T00:00:00Property and CasualtyLiabilityGeneral LiabilityInsured1343Ins Co - Licensed/ActiveOrganizationORG927NEIDHART, HOLLY ANNInsuredNon-Renewal; Premium and RatingYesInformation Furnished2012-06-11T00:00:002012-08-06T00:00:00Property and CasualtyLiabilityGeneral LiabilityInsured653922AgentIndividualORG929DELTA DENTAL OF CALIFORNIAProviderDenial Of ClaimNoOther; No Jurisdiction2012-06-21T00:00:002012-09-26T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured44231Ins Co - Licensed/ActiveOrganizationINDV930OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoCompany Position Upheld; Information Furnished; Complainant Retained Attorney2012-06-21T00:00:002012-08-10T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; UNCOOPERATIVE INSURED931ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling)NoContract Language/Legal Issue2012-06-08T00:00:002012-08-06T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency9825Ins Co - Licensed/ActiveOrganizationINDVNAMED DRIVER POLICY; UNCOOPERATIVE INSURED932VALLEY FORGE INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-06-11T00:00:002012-08-07T00:00:00Property and CasualtyAutomobileIndividual Private Pass1227Ins Co - Licensed/ActiveOrganizationINDV933BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoCompany Position Upheld2012-06-21T00:00:002012-07-24T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life10047Ins Co - Licensed/ActiveOrganizationINDV934AMERICO FINANCIAL LIFE AND ANNUITY INSURANCE COMPANYInsuredDelays (Policyholder Service)NoInformation Furnished2012-06-21T00:00:002012-08-08T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2897Ins Co - Licensed/ActiveOrganizationINDV935TIME INSURANCE COMPANYAgentCommissions; XX-Fraud/ForgeryNoInsufficient Information2012-04-30T00:00:002012-07-11T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1374Insurance ConsultantOrganizationINDV936FAMILY LIFE INSURANCE COMPANYAttorneyDelays (Claims Handling)NoAdditional Monies Received; Claim Settled2012-06-28T00:00:002012-11-14T00:00:00Life, Accident and HealthLife & AnnuityCredit LifeAssociated Subject Person; Deceased Person2657Ins Co - Licensed/ActiveOrganizationINDV938HUMANA HEALTH PLAN OF TEXAS, INC.RelativeDenial Of ClaimNoInformation Furnished; Additional Monies Received2012-06-18T00:00:002012-09-19T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured702Health Maintenance OrgOrganizationINDV939TEXAS FARMERS INSURANCE COMPANYInsuredPremium and RatingNoInsufficient Information; Failure to Timely Respond2012-06-27T00:00:002012-09-10T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE940GALLAGHER BASSETT SERVICES, INC.ProviderDelays (Claims Handling)YesInformation Furnished; Claim Settled2012-06-19T00:00:002012-09-24T00:00:00Workers' CompensationMiscellaneousWorkers' CompensationInsured18848WC Healthcare Provider NtwkOrganizationORG941UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoAdditional Monies Received2012-06-18T00:00:002012-07-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG942BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferYesAdditional Payment Expected2012-06-28T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV943STATE AUTO PROPERTY & CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled2012-06-21T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured28439Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation944HALLMARK COUNTY MUTUAL INSURANCE COMPANYThird PartyCust Service Claim Handling; Denial Of ClaimNoAdditional Payment Expected; Question of Fact2012-06-28T00:00:002012-08-20T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent1505Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DIMINISHED VALUE945GOLDEN RULE INSURANCE COMPANYContracted ProviderUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-06-18T00:00:002012-08-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1057Ins Co - Licensed/ActiveOrganizationORGBUNDLING; GR-Claim Evaluation946DAIRYLAND COUNTY MUTUAL INSURANCE COMPANY OF TEXASThird PartyUnsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished2012-06-19T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass2737Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF947ING LIFE INSURANCE AND ANNUITY COMPANYInsuredXX-Coverage QuestionNoPolicy Not In Force2012-05-25T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life197Ins Co - Licensed/ActiveOrganizationINDVACQUIRED BRAIN INJURY948DIRECT GENERAL INSURANCE COMPANYConsumer (Non-Insured)Delays (Claims Handling)YesAdditional Monies Received; Claim Settled2012-06-21T00:00:002012-08-01T00:00:00Property and CasualtyAutomobileIndividual Private Pass20747Ins Co - Licensed/ActiveOrganizationINDVSUPPLEMENTARY PAYMENT949PHYSICIANS MUTUAL INSURANCE COMPANYSenior CitizenAgent Handling; MisrepresentationNoInformation Furnished2012-06-27T00:00:002012-09-24T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Agent1787Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN949Wallace, AndrewSenior CitizenMisrepresentationNoQuestion of Fact2012-06-27T00:00:002012-09-24T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Agent1139515AgentIndividualINDVSENIOR CITIZEN950STATE LIFE INSURANCE COMPANY, THEInsuredPremium NoticeNoContract Language/Legal Issue2012-06-18T00:00:002012-07-17T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1511Ins Co - Licensed/ActiveOrganizationINDV952GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredDelays (Claims Handling)NoAdditional Payment Expected; Question of Fact2012-06-19T00:00:002012-08-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDV953CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction; Additional Monies Received2012-06-15T00:00:002012-08-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORGMULTIPLE INSUREDS954MOLINA HEALTHCARE OF TEXAS, INC.Contracted ProviderDen/N-Pymt MD Nec Trmt N-EmrgNoInformation Furnished; No Jurisdiction2012-06-12T00:00:002012-09-05T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Person; Insured23469Ins Co - Licensed/ActiveOrganizationORG955BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoNo Jurisdiction2012-05-21T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDVACQUIRED BRAIN INJURY956DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Additional Payment Expected; Company Position Upheld2012-06-18T00:00:002012-08-24T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; LOSS OF USE957UNITEDHEALTHCARE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-06-27T00:00:002012-08-08T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV961BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONHospitalUnsatisfactory Settle/OfferNoClaim Settled2012-06-18T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG962COLONIAL LLOYDSInsuredRefund Of PremiumYesClaim Settled; Information Furnished2012-06-28T00:00:002012-08-22T00:00:00Property and CasualtyHomeownersHomeowners768Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF963LOYA INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished2012-06-19T00:00:002012-08-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass15643Ins Co - Licensed/ActiveOrganizationINDV964SELECTCARE HEALTH PLANS, INC.InsuredDenial Of ClaimNo2012-06-14T00:00:002012-12-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company23566Ins Co - Licensed/ActiveOrganizationINDV964AIM ADMINISTRATORS, LTD.InsuredDenial Of ClaimNoNo Jurisdiction2012-06-14T00:00:002012-12-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company24472Third Party AdministratorsOrganizationINDV965TEXAS HEALTH INSURANCE POOLProviderDelays (Claims Handling)NoClaim Settled2012-06-14T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured9031Govermental EntityOrganizationORG965BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)No2012-06-14T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG966ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received2012-06-21T00:00:002012-09-04T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDV967AETNA LIFE INSURANCE COMPANYProviderDenial Of ClaimYesInformation Furnished; Additional Monies Received2012-06-12T00:00:002012-08-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationORG968BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONThird PartyDelays (Claims Handling)YesAdditional Monies Received2012-06-18T00:00:002012-07-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG969ALLSTATE INSURANCE COMPANYInsuredDelays (Policyholder Service)YesInformation Furnished2012-06-18T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass168Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA969ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredDelays (Policyholder Service)YesInformation Furnished2012-06-18T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA969ALLSTATE TEXAS LLOYD'SInsuredDelays (Policyholder Service)YesInformation Furnished2012-06-18T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass3721Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA970HUMANA INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-06-18T00:00:002012-07-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationINDVPRESCRIPTION971PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimYesInformation Furnished; Company Position Upheld2012-06-19T00:00:002012-08-20T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person1708Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation972UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesAdditional Monies Received; Information Furnished; No Jurisdiction2012-06-15T00:00:002012-08-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGMULTIPLE INSUREDS973TRAVELERS LLOYDS OF TEXAS INSURANCE COMPANYAttorneyDenial Of ClaimNoContract Language/Legal Issue2012-06-19T00:00:002012-08-30T00:00:00Property and CasualtyFire, Allied Lines & CMPBusiness OwnersInsured Company776Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; COVERAGE DISPUTE; DAMAGE DISPUTE; POLICY EXCLUSION; UNDERWRITING CRITERIA; WATER DAMAGE973PRESSMAN, HARRY MERRILLAttorneyAgent HandlingNoInformation Furnished2012-06-19T00:00:002012-08-30T00:00:00Property and CasualtyFire, Allied Lines & CMPBusiness OwnersInsured Company126615AgentIndividualORGADJUSTER'S HANDLING; COVERAGE DISPUTE; DAMAGE DISPUTE; POLICY EXCLUSION; UNDERWRITING CRITERIA; WATER DAMAGE974MEGA LIFE AND HEALTH INSURANCE COMPANY, THERelativeUnsatisfactory Settle/OfferNoInformation Furnished; Additional Payment Expected2012-06-18T00:00:002012-08-15T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured2120Ins Co - Licensed/ActiveOrganizationINDV975INFINITY COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoQuestion of Fact; Contract Language/Legal Issue2012-06-21T00:00:002012-08-29T00:00:00Property and CasualtyAutomobileIndividual Private Pass1197Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING977CAPITOL COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDelays (Claims Handling)NoInsufficient Information; Information Furnished2012-06-25T00:00:002012-09-11T00:00:00Property and CasualtyHomeownersHomeowners2992Ins Co - Licensed/ActiveOrganizationINDV978OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld; Information Furnished2012-06-18T00:00:002012-08-08T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Associated Subject Person1823Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE979UNUM LIFE INSURANCE COMPANY OF AMERICAAgentDelays (Claims Handling)NoAdditional Payment Expected; Claim Settled2012-05-14T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthCredit Disability1327Mortgage LenderOrganizationINDV980TRAVELERS HOME AND MARINE INSURANCE COMPANY, THEInsuredDelays (Claims Handling)NoAdditional Payment Expected; Question of Fact2012-06-19T00:00:002012-07-30T00:00:00Property and CasualtyHomeownersHomeowners3875Ins Co - Licensed/ActiveOrganizationINDVBILL OF RIGHTS - HO; EXAM UNDER OATH; GR-Claim Evaluation982OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoAdditional Payment Expected; Information Furnished2012-06-18T00:00:002012-09-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; SUBROGATION983UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction; Information Furnished; Additional Monies Received2012-06-18T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG984JAMES, MURGLEN EDWARDConsumer (Non-Insured)Misleading AdvertisingYesReferred To2012-06-13T00:00:002012-09-05T00:00:00Life, Accident and HealthAccident and HealthXX-State SpecificAssociated Subject Agency; Associated Subject Company709551AgentIndividualINDV985BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDelays In AuthorizationNoInsufficient Information2012-06-13T00:00:002012-07-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV986BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoInformation Furnished2012-06-18T00:00:002012-09-04T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation987METLIFE INSURANCE COMPANY OF CONNECTICUTRelativeDelays (Policyholder Service)NoInformation Furnished2012-06-15T00:00:002012-07-27T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured1347Ins Co - Licensed/ActiveOrganizationINDV988ALLSTATE INSURANCE COMPANYInsuredPremium and Rating; Use of Credit ReportsNoCompany Position Upheld2012-06-19T00:00:002012-09-05T00:00:00Property and CasualtyAutomobileIndividual Private Pass168Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA988SERNA INSURANCE AGENCY INCInsuredPremium and Rating; Unauthorized Acts; Use of Credit ReportsNoCompany Position Upheld2012-06-19T00:00:002012-09-05T00:00:00Property and CasualtyAutomobileIndividual Private Pass16493Insurance AgencyOrganizationINDVUNDERWRITING CRITERIA989LIBERTY INSURANCE CORPORATIONInsuredDenial Of Claim; Unsatisfactory Settle/OfferNoInformation Furnished; Question of Fact; Company Position Upheld2012-06-21T00:00:002012-10-18T00:00:00Property and CasualtyHomeownersHomeowners3636Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; FOUNDATION ; GR-Claim Evaluation; HAIL; ROOF; SENIOR CITIZEN; SLAB; WATER DAMAGE990CIGNA HEALTHCARE OF TEXAS, INC.PhysicianUnsatisfactory Settle/OfferNoInformation Furnished2012-06-14T00:00:002012-07-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured8294Health Maintenance OrgOrganizationORG991WASHINGTON NATIONAL INSURANCE COMPANYInsuredPremium NoticeNoInformation Furnished2012-06-18T00:00:002012-07-12T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1196Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN992FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld; Additional Payment Expected; Information Furnished2012-06-19T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2623Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; EXAM UNDER OATH993MAMMEN, ROBERT JOSEPHInsuredAgent HandlingNoQuestion of Fact; Information Furnished2012-06-18T00:00:002012-08-13T00:00:00Property and CasualtyAutomobileBusiness AutomobileAssociated Subject Agency874618AgentIndividualINDV994AMERICAN STATES INSURANCE COMPANYThird PartyDelays (Claims Handling)YesClaim Settled; Information Furnished2012-06-19T00:00:002012-09-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass3736Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING995TEXAS LIFE INSURANCE COMPANYRelativeDelays (Claims Handling)NoAdditional Payment Expected; Information Furnished2012-06-13T00:00:002012-07-27T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured1402Ins Co - Licensed/ActiveOrganizationINDV996AMERICAN SPECIALTY INSURANCE & RISK SERVICES, INC.AttorneyDelays (Claims Handling)NoInformation Furnished2012-06-28T00:00:002012-10-15T00:00:00Property and CasualtyLiabilityGeneral LiabilityAssociated Agent; Insured Company23546Third Party AdministratorsOrganizationINDVADJUSTER'S HANDLING997REASSURE AMERICA LIFE INSURANCE COMPANYInsuredCash ValueNoCash Surrender Paid; Information Furnished2012-06-18T00:00:002012-09-26T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1228Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN998CONSECO LIFE INSURANCE COMPANYInsuredCash ValueNoInformation Furnished2012-06-20T00:00:002012-09-05T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2113Ins Co - Licensed/ActiveOrganizationINDV999BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderXX-Usual, Cstmry, Rsnable ChgsNoClaim Settled2012-06-13T00:00:002012-08-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationORG1000TEXAS FARMERS INSURANCE COMPANYInsuredExcessive Rates; Premium and RatingNoCompany Position Upheld2012-06-21T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDVFOUNDATION 1001BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoAdditional Monies Received2012-06-14T00:00:002012-08-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG1002ASI LLOYDSInsuredRefund Of PremiumNoAdditional Monies Received2012-06-19T00:00:002012-08-02T00:00:00Property and CasualtyHomeownersHomeowners14728Ins Co - Licensed/ActiveOrganizationINDV1002HALSTEAD, JASON BRUCEInsuredAgent HandlingNoInformation Furnished2012-06-19T00:00:002012-08-02T00:00:00Property and CasualtyHomeownersHomeowners533461AgentIndividualINDV1003FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished; Company Position Upheld2012-06-19T00:00:002012-08-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA1004GOLDEN RULE INSURANCE COMPANYInsuredMedical NecessityNoContract Language/Legal Issue; Information Furnished2012-06-18T00:00:002012-07-30T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1057Ins Co - Licensed/ActiveOrganizationINDV1005TEXAS MUTUAL INSURANCE COMPANYNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-06-15T00:00:002012-10-19T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkCorrespondent Person; Insured3500Ins Co - Licensed/ActiveOrganizationORG1005TEXAS STAR NETWORK/COVENTRYNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-06-15T00:00:002012-10-19T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkCorrespondent Person; Insured55311WC Healthcare Provider NtwkOrganizationORG1006UNITEDHEALTHCARE INSURANCE COMPANYInsuredCancellation; Continuation of BenefitsNoContract Language/Legal Issue; Information Furnished2012-06-22T00:00:002012-08-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE1007BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-06-14T00:00:002012-07-24T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationINDVEMERGENCY CARE1008PERMANENT GENERAL ASSURANCE CORPORATIONInsuredNon-Disclosure Of Coverage; XX-Premiums MisquotedNoInformation Furnished2012-06-18T00:00:002012-07-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass642Ins Co - Licensed/ActiveOrganizationINDV1009HUMANA INSURANCE COMPANYAttorneyPost-Claim UnderwritingNoInformation Furnished; Contract Language/Legal Issue2012-06-20T00:00:002012-08-29T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1040Ins Co - Licensed/ActiveOrganizationORGRESCISSION1010USAA CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Claim Settled2012-06-19T00:00:002012-08-16T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured3607Ins Co - Licensed/ActiveOrganizationINDVACV; ADJUSTER'S HANDLING; AFTERMARKET PARTS; GR-Claim Evaluation; TOTAL LOSS1011PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-06-28T00:00:002012-09-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation1014MEDCO HEALTH, L.L.C.InsuredOverchargesNoNo Jurisdiction2012-06-09T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H54629OtherOrganizationINDV1015SMITH, COY DONInsurance CompanyXX-Audit DisputeYesInformation Furnished2012-06-18T00:00:002012-09-19T00:00:00Property and CasualtyMiscellaneousP & C MiscCorrespondent Company1129481AgentIndividualINDVAGENT'S FEE1016CAREMARK, L.L.C.InsuredCust Service Claim Handling; Unsatisfactory Settle/OfferNoInformation Furnished2012-06-11T00:00:002012-09-19T00:00:00Health Maintenance OrgAccident and HealthGroup A&H56496Third Party AdministratorsOrganizationINDVPHARMACY; PRESCRIPTION; SENIOR CITIZEN1017ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimYesQuestion of Fact2012-05-17T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation; UNCOOPERATIVE INSURED1018LIFE INSURANCE COMPANY OF NORTH AMERICAInsuredDenial Of ClaimYesCorrective Action Taken; Additional Payment Expected2012-06-15T00:00:002012-07-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2157Ins Co - Licensed/ActiveOrganizationINDV1019COLONIAL PENN LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished2012-06-18T00:00:002012-08-07T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2856Ins Co - Licensed/ActiveOrganizationINDV1019PAIGE, ROBERT ALLENInsuredMisrepresentationNoInformation Furnished2012-06-18T00:00:002012-08-07T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H979462AgentIndividualINDV1020AMERICAN RISK INSURANCE COMPANY, INC.InsuredDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-06-28T00:00:002012-09-06T00:00:00Property and CasualtyHomeownersHomeowners27377Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; ROOF1021NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA.InsuredUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-06-14T00:00:002012-08-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1931Ins Co - Licensed/ActiveOrganizationINDV1022GUARDIAN LIFE INSURANCE COMPANY OF AMERICA, THEInsuredDelays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-06-11T00:00:002012-07-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2414Ins Co - Licensed/ActiveOrganizationINDV1023UNITED HEALTHCARE INSURANCE COMPANYProviderMedical NecessityNoNo Jurisdiction2012-06-13T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&H70310Ins Co - Licensed/ActiveOrganizationORGPRESCRIPTION1024TEXAS HEALTHSPRING, LLCProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-06-20T00:00:002012-08-22T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Person; Insured18634Health Maintenance OrgOrganizationORG1025STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Payment Expected; Complainant Retained Attorney; Information Furnished2012-06-19T00:00:002012-07-31T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDV1026BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoInformation Furnished; Additional Monies Received2012-06-14T00:00:002012-08-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG1027PHYSICIANS HEALTH CHOICE OF TEXAS, LLCProviderDelays (Claims Handling)NoInformation Furnished; No Jurisdiction2012-06-27T00:00:002012-08-08T00:00:00Medicare HMOAccident and HealthGroup A&HCorrespondent Person17170Ins Co - Licensed/ActiveOrganizationORG1029ELCO ADMINISTRATIVE SERVICESThird PartyUnsatisfactory Settle/OfferNoNo Jurisdiction; Question of Fact2012-06-25T00:00:002012-08-08T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured Company13174Third Party AdministratorsOrganizationINDVGR-Claim Evaluation; LOSS OF USE1030HOME STATE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoClaim Settled; Company Position Upheld2012-06-21T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass2362Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE1032GERMAN-AMERICAN FARM MUTUALInsuredDelays (Claims Handling)NoCompany Position Upheld; Information Furnished; No Jurisdiction2012-06-19T00:00:002012-08-01T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent2467Ins Co - Licensed/ActiveOrganizationINDV1033ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYAttorneyCust Service Claim Handling; Denial Of ClaimNoAdditional Monies Received; Additional Payment Expected; Information Furnished2012-06-18T00:00:002012-10-13T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured936Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation; UNDERWRITING CRITERIA1034UNITEDHEALTHCARE INSURANCE COMPANYNon-Contracted ProviderXX-Usual, Cstmry, Rsnable ChgsNoContract Language/Legal Issue; Information Furnished2012-06-11T00:00:002013-05-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG1035UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.PhysicianUnsatisfactory Settle/OfferNoNo Jurisdiction2012-06-18T00:00:002012-08-07T00:00:00Medicare Managed Care for HMOAccident and HealthGroup A&HCorrespondent Person; Insured14666Health Maintenance OrgOrganizationORG1036UNITEDHEALTHCARE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoClaim Settled2012-06-22T00:00:002012-08-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV1039BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2011-10-05T00:00:002012-08-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG1040UNITEDHEALTHCARE INSURANCE COMPANYProviderRecoupment Of Claims Payment; SB418 Rule ViolationYesAdditional Monies Received; Claim Settled2012-06-14T00:00:002012-08-08T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV1041HARTFORD FIRE INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)NoNo Jurisdiction2012-06-18T00:00:002012-07-26T00:00:00Property and CasualtyAutomobileXX-CommercialAssociated Subject Person; Insured Company; Third Party Admin-Non Licensed2382Ins Co - Licensed/ActiveOrganizationINDV1042HERITAGE UNION LIFE INSURANCE COMPANYAttorneyPremium Notice; XX-Coverage QuestionNoContract Language/Legal Issue; Information Furnished2012-06-27T00:00:002012-08-23T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Agent2991Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN1044GERBER LIFE INSURANCE COMPANYInsuredRefund Of PremiumNoContract Language/Legal Issue2012-06-11T00:00:002012-11-27T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2465Ins Co - Licensed/ActiveOrganizationINDV1047AETNA HEALTH INC.ProviderUnsatisfactory Settle/OfferNoAdditional Payment Expected; No Jurisdiction; Information Furnished2012-06-15T00:00:002012-08-16T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Person; Insured3522Ins Co - Licensed/ActiveOrganizationORGMULTIPLE INSUREDS1048HUMANA INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesInsufficient Information; Contract Language/Legal Issue; Additional Monies Received2012-06-13T00:00:002012-08-06T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured1040Ins Co - Licensed/ActiveOrganizationORG1049AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-06-22T00:00:002012-07-20T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured245Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation1050MANAGED DENTALGUARD, INC.ProviderDelays (Claims Handling)YesClaim Settled2012-06-11T00:00:002012-09-10T00:00:00Health Maintenance OrgAccident and HealthIndividual A & HAssociated Subject Person; Insured10898Ins Co - Licensed/ActiveOrganizationORG1051BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays In AuthorizationNoNo Jurisdiction2012-06-27T00:00:002012-07-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV1052MERCHANT BENEFITS ASSOCIATIONProviderDelays (Claims Handling)YesClaim Settled; Additional Payment Expected; Additional Monies Received2012-06-20T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthDiscount Health Care ProgramInsured66652Third Party AdministratorsOrganizationORG1054AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue; No Jurisdiction2012-06-15T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationORGMULTIPLE INSUREDS1055AETNA LIFE INSURANCE COMPANYInsuredCoordination of BenefitsNoNo Jurisdiction; Information Furnished2012-05-31T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV1057HUMANA INSURANCE COMPANYProviderDenial Of ClaimNoAdditional Monies Received; Information Furnished2012-06-12T00:00:002012-08-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationORG1058UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesInformation Furnished; No Jurisdiction; Stat Pen Pd-46 To 90 Dys Late2012-06-11T00:00:002012-08-06T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGBUNDLING1060AMERICAN FIDELITY ASSURANCE COMPANYRelativeCash ValueNoInformation Furnished2012-06-20T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person138Ins Co - Licensed/ActiveOrganizationINDV1060UNITED OF OMAHA LIFE INSURANCE COMPANYRelativeCash ValueNoInformation Furnished2012-06-20T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person1281Ins Co - Licensed/ActiveOrganizationINDV1060UNITED BENEFIT LIFE INSURANCE COMPANYRelativeOtherNo2012-06-20T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person3360OtherOrganizationINDV1061WASHINGTON NATIONAL INSURANCE COMPANYRelativeDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-06-14T00:00:002012-08-03T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured1196Ins Co - Licensed/ActiveOrganizationINDV1063SOUTHERN VANGUARD INSURANCE COMPANYConsumer (Non-Insured)Refusal to InsureNoInformation Furnished2012-06-21T00:00:002012-09-11T00:00:00Property and CasualtyHomeownersHomeowners9429Ins Co - Licensed/ActiveOrganizationINDV1064AETNA LIFE INSURANCE COMPANYRelativeDenial Of ClaimYesAdditional Payment Expected2012-06-15T00:00:002012-07-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDV1065OFFICE ALLYInsuredUnsatisfactory Settle/OfferNoOther2012-06-25T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&H66659No Entity Complained AgainstOrganizationINDV1067OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDelays (Claims Handling)NoCompany Position Upheld; Information Furnished2012-06-18T00:00:002012-10-08T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Company1823Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; EXAM UNDER OATH1068SIRIUS INTERNATIONAL INSURANCE CORPORATIONInsuredDenial Of Claim; Pre-Existing ConditionNoInformation Furnished; Additional Payment Expected2012-06-14T00:00:002012-07-31T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company52206Ins Co - Surplus LinesOrganizationINDV1069SUPERIOR HEALTHPLAN, INC.AttorneyUsual And CustomaryNoNo Jurisdiction2012-06-22T00:00:002012-09-19T00:00:00Health Maintenance OrgAccident and HealthIndividual A & H10198Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1070REASSURE AMERICA LIFE INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished2012-06-15T00:00:002012-09-19T00:00:00Health Maintenance OrgLife & AnnuityIndividual Life1228Ins Co - Licensed/ActiveOrganizationINDV1071NATIONWIDE GENERAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoCompany Position Upheld; Information Furnished2012-06-21T00:00:002012-08-23T00:00:00Property and CasualtyHomeownersRentalAssociated Subject Person1934Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; MOLD1072FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoQuestion of Fact; Information Furnished2012-06-21T00:00:002012-08-14T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA1073HUMANA HEALTH PLAN OF TEXAS, INC.ProviderCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received; No Jurisdiction2012-06-12T00:00:002012-08-14T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Person; Insured; Third Party Admin-Non Licensed702Ins Co - Licensed/ActiveOrganizationINDV1074AETNA LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoInsufficient Information2012-06-25T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV1075GOVERNMENT EMPLOYEES INSURANCE COMPANYInsurance CompanyDenial Of ClaimNoQuestion of Fact; Company Position Upheld2011-11-08T00:00:002012-07-25T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1076CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDenial Of Claim; Unsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-06-28T00:00:002012-08-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Associated Subject Person; Correspondent Company; Correspondent Person; Insured2851Ins Co - Licensed/ActiveOrganizationORG1077UNDERWRITERS AT LLOYD'S, LONDONInsuredCancellationNoInformation Furnished2012-06-21T00:00:002012-09-06T00:00:00Property and CasualtyHomeownersHomeowners55949Ins Co - Surplus LinesOrganizationINDV1078RELIABLE LIFE INSURANCE COMPANY, THEInsuredDelays (Policyholder Service)NoAdditional Payment Expected; Information Furnished2012-06-11T00:00:002012-07-31T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities1704Ins Co - Licensed/ActiveOrganizationINDV1078Ramirez, Jose AsuncionInsuredCash ValueNoInformation Furnished2012-06-11T00:00:002012-07-31T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities1129840AgentIndividualINDV1079CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-06-28T00:00:002012-08-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Ins Co - Licensed/ActiveOrganizationORGBUNDLING1080UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoRecord Only2012-06-15T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDVBUNDLING1081SOUTHERN COUNTY MUTUAL INSURANCE COMPANYInsuredExcessive Rates; Premium and RatingYesInformation Furnished2012-06-21T00:00:002012-08-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass1583Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA1083CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-06-28T00:00:002012-08-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Ins Co - Licensed/ActiveOrganizationORGBUNDLING1084UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoClaim Settled2012-06-15T00:00:002012-08-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDVBUNDLING1085UNDERWRITERS AT LLOYD'S, LONDONInsuredDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-05-31T00:00:002012-07-31T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency; Associated Subject Company55949Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; WATER DAMAGE1086DELTA DENTAL INSURANCE COMPANYProviderDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-06-21T00:00:002012-08-27T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2752Ins Co - Licensed/ActiveOrganizationINDV1087RELIABLE LIFE INSURANCE COMPANY, THEInsuredDelays (Policyholder Service)NoInformation Furnished; Premium Refunded2012-06-11T00:00:002012-07-30T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities1704Ins Co - Licensed/ActiveOrganizationINDV1087Ramirez, Jose AsuncionInsuredCash ValueNoInsufficient Information2012-06-11T00:00:002012-07-30T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities1129853AgentIndividualINDV1088HUMANA INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNo2012-06-27T00:00:002012-08-06T00:00:00Health Maintenance OrgAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationINDV1088DENTICARE, INC.InsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-06-27T00:00:002012-08-06T00:00:00Health Maintenance OrgAccident and HealthGroup A&H3712Health Maintenance OrgOrganizationINDV1089OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received; Company Position Upheld; Information Furnished2012-06-15T00:00:002012-08-16T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDV1090RELIABLE LIFE INSURANCE COMPANY, THEInsuredDelays (Policyholder Service)NoInformation Furnished; Additional Payment Expected2012-06-11T00:00:002012-07-30T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities1704Ins Co - Licensed/ActiveOrganizationINDV1090RAMIREZ, JOSE ASUNCIONInsuredCash ValueNoInformation Furnished2012-06-11T00:00:002012-07-30T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities49464AgentIndividualINDV1091AETNA LIFE INSURANCE COMPANYInsuredDelays (Policyholder Service)NoContract Language/Legal Issue2012-06-27T00:00:002012-08-02T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured245Ins Co - Licensed/ActiveOrganizationINDV1092UNIVERSAL NORTH AMERICA INSURANCE COMPANYInsuredLiability DisputeNoInformation Furnished; Contract Language/Legal Issue2012-06-28T00:00:002012-12-05T00:00:00Property and CasualtyAutomobileIndividual Private Pass23526Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation1093REPUBLIC LLOYDSConsumer (Non-Insured)Unsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished2012-06-15T00:00:002012-09-10T00:00:00Property and CasualtyHomeownersHomeownersCorrespondent Company; Insured2299Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; HAIL1094SOUTHERN COUNTY MUTUAL INSURANCE COMPANYInsuredRefund Of PremiumYesInformation Furnished; Premium Refunded2012-06-28T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass1583Ins Co - Licensed/ActiveOrganizationINDV1095JACKSON NATIONAL LIFE INSURANCE COMPANYRelativeDelays (Policyholder Service)NoInformation Furnished2012-06-22T00:00:002012-08-06T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured3718Ins Co - Licensed/ActiveOrganizationINDV1096FORETHOUGHT LIFE INSURANCE COMPANYRelativeMisrepresentationNoNo Jurisdiction2012-06-11T00:00:002012-09-26T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities728Ins Co - Licensed/ActiveOrganizationINDV1096Marshall, Wesley NormanRelativeMisrepresentationNoNo Jurisdiction2012-06-11T00:00:002012-09-26T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities1137448AgentIndividualINDV1097LIFE INSURANCE COMPANY OF THE SOUTHWESTInsuredCash ValueNoAdditional Payment Expected; Information Furnished2012-06-13T00:00:002012-08-06T00:00:00Life, Accident and HealthLife & AnnuityGroup Life2158Ins Co - Licensed/ActiveOrganizationINDV1098ASI LLOYDSInsuredCancellationNoAdditional Monies Received2012-06-15T00:00:002012-10-23T00:00:00Property and CasualtyHomeownersHomeowners14728Ins Co - Licensed/ActiveOrganizationINDV1098MURPHY, CHRISTOPHER VERNONInsuredAgent HandlingYes2012-06-15T00:00:002012-10-23T00:00:00Property and CasualtyHomeownersHomeowners659500AgentIndividualINDV1099BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-06-27T00:00:002012-08-29T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured10047Ins Co - Licensed/ActiveOrganizationINDV1100R.V.O.S. FARM MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-06-15T00:00:002012-09-24T00:00:00Property and CasualtyHomeownersHomeowners2621Ins Co - Licensed/ActiveOrganizationINDVROOF1101NATIONAL WESTERN LIFE INSURANCE COMPANYInsuredAgent Handling; Misrepresentation; XX-FiduciaryNoInformation Furnished2012-06-21T00:00:002012-08-10T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities1933Ins Co - Licensed/ActiveOrganizationINDV1101CARLIN, KELLIE ANNInsuredMisrepresentationNoInformation Furnished2012-06-21T00:00:002012-08-10T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities219223AgentIndividualINDV1102CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-06-14T00:00:002012-08-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured25422Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN1104UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-06-11T00:00:002012-10-23T00:00:00Medicare HMOAccident and HealthIndividual A & HInsured1348Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN1105ALTRE INSURANCE AGENCY INCAgentUnauthorized ActsNoInsufficient Information2012-06-15T00:00:002012-09-19T00:00:00Property and CasualtyMiscellaneousP & C MiscAssociated Agent21832Insurance AgencyOrganizationINDV1106LINCOLN NATIONAL LIFE INSURANCE COMPANY, THEInsuredDenial Of ClaimNoInformation Furnished2012-06-13T00:00:002012-08-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2172Ins Co - Licensed/ActiveOrganizationINDV1107AMERICAN NATIONAL INSURANCE COMPANYRelativeRefund Of PremiumNoInformation Furnished; Policy Issued/Restored2012-06-27T00:00:002012-08-08T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured135Ins Co - Licensed/ActiveOrganizationINDV1108MVP Health Insurance Company IncProviderDelays (Claims Handling)NoInformation Furnished; Additional Monies Received2012-06-22T00:00:002012-08-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured66692OtherOrganizationORGGR-Claim Evaluation1109METROPOLITAN LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-06-28T00:00:002012-08-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured13191Ins Co - Licensed/ActiveOrganizationINDV1110TEXAS FARMERS INSURANCE COMPANYInsuredDelays (Policyholder Service); Refund Of PremiumNoPremium Refunded2012-06-13T00:00:002012-08-07T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDV1112WELLINGTON INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoClaim Settled; Additional Monies Received2012-06-18T00:00:002012-08-28T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person18251Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; HAIL; OVERHEAD AND PROFIT; ROOF; SUPPLEMENTARY PAYMENT1113BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoNo Jurisdiction2012-06-28T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG1114GROUP & PENSION ADMINISTRATORS, INC.ProviderDelays (Claims Handling); Unsatisfactory Settle/OfferNoNo Jurisdiction2012-06-11T00:00:002012-08-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&H32390Ins Co - Licensed/ActiveOrganizationINDV1115METROPOLITAN LIFE INSURANCE COMPANYAttorneyUnsatisfactory Settle/OfferNoClaim Settled2012-06-13T00:00:002012-08-17T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life13191Ins Co - Licensed/ActiveOrganizationINDV1116ACE AMERICAN INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)NoInformation Furnished; Additional Payment Expected2012-06-20T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured2327Ins Co - Licensed/ActiveOrganizationINDV1117UNITEDHEALTHCARE INSURANCE COMPANYInsuredDelays (Claims Handling)No2012-06-14T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV1117MEDCO HEALTH, L.L.C.InsuredDelays (Claims Handling)NoClaim Settled2012-06-14T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H54629Ins Co - Licensed/ActiveOrganizationINDV1119JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.)InsuredDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue; Additional Payment Expected2012-06-28T00:00:002012-08-30T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1148Ins Co - Licensed/ActiveOrganizationINDV1120METROPOLITAN LIFE INSURANCE COMPANYInsuredExcessive Rates; Premium and RatingNoContract Language/Legal Issue2012-06-11T00:00:002012-08-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&H13191Ins Co - Licensed/ActiveOrganizationINDV1121SANTA FE AUTO INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled; Additional Monies Received2012-06-18T00:00:002012-08-07T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured27766Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1122UNITEDHEALTHCARE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-06-28T00:00:002012-08-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV1123UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue; No Jurisdiction; Information Furnished2012-06-15T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV1124ELECTRIC INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferYesInformation Furnished; Contract Language/Legal Issue2012-06-18T00:00:002012-09-24T00:00:00Property and CasualtyHomeownersHomeowners2719Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE; ROOF1125UNUM LIFE INSURANCE COMPANY OF AMERICAInsuredMisrepresentationNoRecord Only2012-06-12T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1327Ins Co - Licensed/ActiveOrganizationINDV1126TEXAS MUTUAL INSURANCE COMPANYNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-06-20T00:00:002012-10-19T00:00:00Workers Compensation NetworkMiscellaneousWorkers' CompensationAssociated Subject Company; Correspondent Person; Insured32540Ins Co - Licensed/ActiveOrganizationORG1127HOME STATE COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished2012-06-18T00:00:002012-08-15T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2362Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1128AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesAdditional Monies Received; Information Furnished2012-06-28T00:00:002012-08-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG1129STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Company Position Upheld2012-06-18T00:00:002012-08-16T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; TOTAL LOSS1130UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-06-28T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG1131SOUTHWEST SERVICE LIFE INSURANCE COMPANYRelativeUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-06-12T00:00:002012-08-01T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesInsured1542Ins Co - Licensed/ActiveOrganizationINDV1132HOME STATE COUNTY MUTUAL INSURANCE COMPANYAttorneyDelays (Claims Handling)NoInformation Furnished2012-06-18T00:00:002012-08-08T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Person; Insured2362Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1133TEXAS MUTUAL INSURANCE COMPANYNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-06-20T00:00:002012-10-19T00:00:00Workers Compensation NetworkMiscellaneousWorkers' CompensationAssociated Subject Company; Correspondent Person; Injured Employee32540Ins Co - Licensed/ActiveOrganizationORG1134STEWART, CHARLES EDWARDAgentDelays (Claims Handling)NoOther2012-06-18T00:00:002012-10-12T00:00:00Life, Accident and HealthLife & AnnuityCredit LifeAssociated Subject Company; Insured91601AgentIndividualINDV1135AETNA HEALTH INC.ProviderUnsatisfactory Settle/OfferNoCompany Position Upheld; Contract Language/Legal Issue2012-06-11T00:00:002012-07-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured3522Ins Co - Licensed/ActiveOrganizationINDV1136UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.HospitalDelays (Claims Handling); Unsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-06-28T00:00:002012-09-13T00:00:00Medicare HMOAccident and HealthGroup A&HCorrespondent Person; Insured14666Ins Co - Licensed/ActiveOrganizationORG1138CYPRESS TEXAS LLOYDSInsuredEndorsement / RiderNoAdditional Monies Received; Information Furnished; Additional Payment Expected2012-06-28T00:00:002012-08-29T00:00:00Property and CasualtyHomeownersHomeowners18280Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1141HUMANA HEALTH PLAN OF TEXAS, INC.ProviderDenial Of ClaimYesAdditional Monies Received2012-06-28T00:00:002012-08-21T00:00:00Health Maintenance OrgAccident and HealthGroup A&H702Ins Co - Licensed/ActiveOrganizationORG1142MOLINA HEALTHCARE OF TEXAS, INC.Non-Contracted ProviderDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-06-15T00:00:002012-09-24T00:00:00Health Maintenance OrgAccident and HealthXX-State SpecificCorrespondent Person; Insured23469Ins Co - Licensed/ActiveOrganizationORG1143MOLINA HEALTHCARE OF TEXAS, INC.Contracted ProviderDen/N-Pymt MD Nec Trmt N-EmrgNoNo Jurisdiction; Information Furnished2012-06-12T00:00:002012-09-11T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Person; Insured23469Ins Co - Licensed/ActiveOrganizationORG1145AMERICAN ACCESS CASUALTY COMPANYInsuredDelays (Claims Handling)NoInformation Furnished; Claim Settled2012-07-02T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private Pass30332Ins Co - Licensed/ActiveOrganizationINDV1147UNITEDHEALTHCARE INSURANCE COMPANYRelativeUnsatisfactory Settle/OfferYesClean Claims Violation; Stat Pen Pd-Over 90 Dys Late; Additional Monies Received2012-06-15T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company1348Ins Co - Licensed/ActiveOrganizationINDV1148AETNA LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue2012-06-11T00:00:002012-08-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDV1149MHEALTH, INC.PhysicianDenial Of Claim; Timely Filing DeficiencyNoContract Language/Legal Issue; No Jurisdiction; Information Furnished2012-06-28T00:00:002012-08-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured35501Third Party AdministratorsOrganizationINDVGR-Claim Evaluation1150BURKHALTER, BRADLY GLENInsuredUnauthorized ActsYesReferred for Disciplinary Actn; Failure to Timely Respond2012-06-20T00:00:002012-10-22T00:00:00Property and CasualtyHomeownersHomeowners731464AgentIndividualINDV1151MOLINA HEALTHCARE OF TEXAS, INC.RelativeCust Service Claim HandlingNoInformation Furnished; No Jurisdiction2012-06-13T00:00:002012-10-16T00:00:00Health Maintenance OrgAccident and HealthGroup A&HAssociated Subject Person; Insured23469Ins Co - Licensed/ActiveOrganizationINDV1152HUMANA INSURANCE COMPANYProviderCust Service Claim Handling; Unsatisfactory Settle/OfferNoInformation Furnished; Insufficient Information; Contract Language/Legal Issue2012-06-28T00:00:002013-07-09T00:00:00Life, Accident and HealthMiscellaneousNo Line SpecifiedGR Elected Official1040Ins Co - Licensed/ActiveOrganizationORG1154TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICAThird PartyDenial Of ClaimNoQuestion of Fact; Information Furnished2012-06-28T00:00:002012-08-28T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured Company1345Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF1155UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-06-11T00:00:002012-08-08T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV1156R H ADMINISTRATORS, INC.ProviderDelays (Claims Handling)NoNo Jurisdiction2012-06-07T00:00:002012-07-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured12370Ins Co - Licensed/ActiveOrganizationINDV1157UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDenial Of ClaimNoNo Jurisdiction2012-06-28T00:00:002012-07-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1158DALLAS NATIONAL INSURANCE COMPANYInsuredDelays (Claims Handling)YesCompany Position Upheld2012-06-28T00:00:002012-09-26T00:00:00Property and CasualtyLiabilityGeneral Liability51235Ins Co - Licensed/ActiveOrganizationORG1159ALLSTATE TEXAS LLOYD'SInsuredCust Service Claim Handling; Delays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-06-20T00:00:002012-09-21T00:00:00Property and CasualtyHomeownersHomeowners3721Ins Co - Licensed/ActiveOrganizationINDV1160UNITED OF OMAHA LIFE INSURANCE COMPANYInsuredRefusal to InsureNoInformation Furnished; Contract Language/Legal Issue2012-06-13T00:00:002012-08-29T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1281Ins Co - Licensed/ActiveOrganizationINDV1161UNITEDHEALTHCARE INSURANCE COMPANYInsuredCoordination of Benefits; Denial Of ClaimNoInformation Furnished; No Jurisdiction2012-06-28T00:00:002012-08-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE1162LIBERTY LLOYDS OF TEXAS INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished2012-06-29T00:00:002012-09-11T00:00:00Property and CasualtyHomeownersHomeowners11084Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1163HUMANA INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished2012-06-11T00:00:002012-08-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationORGBUNDLING1164DRIVER'S INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Question of Fact2012-06-20T00:00:002012-08-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass2038Ins Co - Licensed/ActiveOrganizationINDV1166HEALTHSMART BENEFIT SOLUTIONS, INC.InsuredDenial Of ClaimNoNo Jurisdiction; Other2012-06-15T00:00:002012-12-19T00:00:00Health Maintenance OrgAccident and HealthGroup A&HAssociated Subject Company18847Health Maintenance OrgOrganizationINDV1166ARCADIAN HEALTH PLAN, INC.InsuredDenial Of ClaimNo2012-06-15T00:00:002012-12-19T00:00:00Health Maintenance OrgAccident and HealthGroup A&HAssociated Subject Company22588Health Maintenance OrgOrganizationINDV1167BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDelays (Underwriting); Premium and RatingNoCorrective Action Taken; Additional Monies Received2012-06-28T00:00:002012-09-17T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life10047Ins Co - Licensed/ActiveOrganizationINDV1168BRAVO HEALTH TEXAS, INC.ProviderDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-06-28T00:00:002012-08-21T00:00:00Medicare HMOAccident and HealthGroup A&HCorrespondent Person; Insured22975Ins Co - Licensed/ActiveOrganizationORG1169First American Home BuyersInsuredDelays (Policyholder Service)NoRecord Only2012-06-29T00:00:002012-09-19T00:00:00Property and CasualtyMiscellaneousHomeowner Warranty66735OtherOrganizationINDVADJUSTER'S HANDLING1170CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction; Additional Monies Received2012-06-28T00:00:002012-10-09T00:00:00Health Maintenance OrgAccident and HealthIndividual A & HInsured25422Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; SENIOR CITIZEN1171GOLDEN RULE INSURANCE COMPANYOtherClaim Recoding/BundlingNoInformation Furnished2012-06-11T00:00:002012-08-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1057Ins Co - Licensed/ActiveOrganizationORG1172SAFECO INSURANCE COMPANY OF INDIANAInsuredDenial Of ClaimNoContract Language/Legal Issue; Question of Fact; Information Furnished2012-07-03T00:00:002012-09-26T00:00:00Property and CasualtyHomeownersHomeowners2496Ins Co - Licensed/ActiveOrganizationINDVHAIL; ROOF1173OCCIDENTAL LIFE INSURANCE COMPANY OF NORTH CAROLINARelativeDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-06-13T00:00:002012-09-26T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1873Ins Co - Licensed/ActiveOrganizationINDV1173CHARGOIS, EDDIE MRelativeMisrepresentationNoInformation Furnished2012-06-13T00:00:002012-09-26T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life669845AgentIndividualINDV1174ACCC INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-07-03T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDV1175PRUDENTIAL INSURANCE COMPANY OF AMERICA, THERelativeUnsatisfactory Settle/OfferNoClaim Settled2012-06-28T00:00:002012-08-27T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Person; Insured1729Ins Co - Licensed/ActiveOrganizationINDV1176WASHINGTON NATIONAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-06-28T00:00:002012-08-22T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1196Ins Co - Licensed/ActiveOrganizationINDVCANCER; GR-Claim Evaluation1177BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONOtherUnsatisfactory Settle/OfferNoInformation Furnished2012-06-11T00:00:002012-09-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationORG1178DELTA LLOYDS INSURANCE COMPANY OF HOUSTON, TEXASInsuredNon-RenewalNoInformation Furnished; Contract Language/Legal Issue2012-07-03T00:00:002012-10-13T00:00:00Property and CasualtyHomeownersHomeowners2750Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA1179BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-07-02T00:00:002012-08-21T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationINDV1180PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredRefund Of PremiumNoInformation Furnished; Contract Language/Legal Issue2012-07-03T00:00:002012-09-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDV1180PECAN STREET INSURANCE AND FINANCIAL SERVICES, INC.InsuredAgent HandlingNoInformation Furnished; Contract Language/Legal Issue2012-07-03T00:00:002012-09-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass29239Insurance AgencyOrganizationINDV1181SELECTCARE HEALTH PLANS, INC.InsuredDelays (Claims Handling)NoNo Jurisdiction2012-06-13T00:00:002012-08-08T00:00:00Health Maintenance OrgAccident and HealthGroup A&H23566Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN1182RANCHERS AND FARMERS MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-07-03T00:00:002012-08-28T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company1689Ins Co - Licensed/ActiveOrganizationINDV1183UNITEDHEALTHCARE INSURANCE COMPANYRelativeCust Service Claim Handling; Denial Of ClaimYesAdditional Monies Received; Information Furnished2012-06-26T00:00:002012-08-29T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1348Ins Co - Licensed/ActiveOrganizationINDV1184BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderAssignment of BenefitsNoNo Jurisdiction2012-06-13T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationORG1185PEERLESS INDEMNITY INSURANCE COMPANYThird PartyDenial Of ClaimYesClaim Settled2012-07-03T00:00:002012-11-29T00:00:00Property and CasualtyAutomobileIndividual Private Pass47997Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1186BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-07-02T00:00:002012-08-29T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured10047Ins Co - Licensed/ActiveOrganizationINDV1187SOUTHWEST SERVICE LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoQuestion of Fact; Contract Language/Legal Issue; Additional Payment Expected2012-06-13T00:00:002012-07-18T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1542Ins Co - Licensed/ActiveOrganizationINDV1188ALLSTATE INDEMNITY COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Additional Payment Expected2012-07-03T00:00:002012-08-29T00:00:00Property and CasualtyAutomobileIndividual Private Pass167Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1189STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoCompany Position Upheld; Information Furnished2012-06-21T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV1190FOREMOST COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Additional Payment Expected2012-07-03T00:00:002012-08-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass2530Ins Co - Licensed/ActiveOrganizationINDVDRIVER NOT COVERED; HAIL1191ALLSTATE COUNTY MUTUAL INSURANCE COMPANYInsuredRefund Of PremiumNoInformation Furnished; Company Position Upheld2012-06-20T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass2228Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA1192UNITED HEALTHCARE SERVICES, INC.InsuredUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-07-02T00:00:002012-08-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company36825Third Party AdministratorsOrganizationINDVCOVERAGE DISPUTE1193UMR, INC.ProviderDenial Of ClaimNoNo Jurisdiction2012-06-12T00:00:002012-09-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&H23490Third Party AdministratorsOrganizationORG1194GARRISON PROPERTY AND CASUALTY INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferYesClaim Settled; Information Furnished2012-07-03T00:00:002012-09-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass1697Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1195FARMERS INSURANCE EXCHANGEInsuredUnsatisfactory Settle/OfferNoAdditional Payment Expected; Company Position Upheld2012-06-20T00:00:002012-08-06T00:00:00Property and CasualtyHomeownersHomeowners2668Ins Co - Licensed/ActiveOrganizationINDVROOF1196OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYLienholderDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-07-03T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1197HOME STATE COUNTY MUTUAL INSURANCE COMPANYAttorneyUnsatisfactory Settle/OfferNoInformation Furnished2012-06-20T00:00:002012-08-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Associated Subject Person2362Ins Co - Licensed/ActiveOrganizationINDVCOMPARATIVE NEGLIGENCE1198TEXAS STAR NETWORK/COVENTRYNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-06-15T00:00:002012-12-20T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Company; Correspondent Person; Insured55311WC Healthcare Provider NtwkOrganizationORG1199UNITED TEACHER ASSOCIATES INSURANCE COMPANYRelativeDenial Of ClaimNoAdditional Monies Received; Information Furnished2012-06-12T00:00:002012-08-13T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H3486Ins Co - Licensed/ActiveOrganizationINDV1200RELIABLE LIFE INSURANCE COMPANY, THEBeneficiaryCust Service Claim Handling; Unsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-06-28T00:00:002012-11-20T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured1704Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1201OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeNoInsufficient Information2012-06-20T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDV1202STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoQuestion of Fact2012-06-20T00:00:002012-08-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1203OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Policy Issued/Restored2012-07-03T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1204GEICO INDEMNITY COMPANYInsuredUnsatisfactory Settle/OfferYesCorrective Action Taken2012-07-03T00:00:002012-08-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass2785Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation1205GEICO INDEMNITY COMPANYAttorneyRecoupment Of Claims PaymentYesInformation Furnished2012-07-05T00:00:002012-08-01T00:00:00Property and CasualtyAutomobileIndividual Private Pass2785Ins Co - Licensed/ActiveOrganizationINDV1206GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-06-20T00:00:002012-08-10T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company2486Ins Co - Licensed/ActiveOrganizationINDV1207UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesAdditional Monies Received; Information Furnished2012-06-11T00:00:002012-08-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationORG1208PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and RatingNoContract Language/Legal Issue; Information Furnished2012-07-03T00:00:002012-08-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA1208ASAP INSURANCE AGENCY, INC.InsuredPremium and RatingNo2012-07-03T00:00:002012-08-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass28767AgentOrganizationINDVUNDERWRITING CRITERIA1209CHICAGO TITLE INSURANCE COMPANYInsuredDelays (Policyholder Service)YesCorrective Action Taken2012-06-20T00:00:002012-08-20T00:00:00Property and CasualtyMiscellaneousTitle InsuranceAssociated Subject Company51988Ins Co - Licensed/ActiveOrganizationORG1210TEXAS MUTUAL INSURANCE COMPANYNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-06-15T00:00:002012-10-22T00:00:00Workers Compensation NetworkMiscellaneousWorkers' CompensationAssociated Subject Company; Correspondent Person; Insured3500Ins Co - Licensed/ActiveOrganizationORG1211STATE FARM LLOYDSInsuredUnsatisfactory Settle/OfferNoAdditional Monies Received; Question of Fact2012-06-21T00:00:002012-07-26T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation; HAIL; POLICY EXCLUSION; ROOF1212UNITEDHEALTHCARE INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; Additional Monies Received2012-07-02T00:00:002012-08-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV1213BRISTOL WEST SPECIALTY INSURANCE COMPANYInsuredDelays (Claims Handling)NoClaim Settled; Information Furnished2012-06-29T00:00:002012-09-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass8129Ins Co - Licensed/ActiveOrganizationINDVTOTAL LOSS1214AETNA LIFE INSURANCE COMPANYProviderDenial Of ClaimNoCompany Position Upheld2012-06-15T00:00:002012-09-24T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H245Ins Co - Licensed/ActiveOrganizationINDV1215LIFE INSURANCE COMPANY OF NORTH AMERICAInsuredDelays (Claims Handling); Denial Of ClaimNoAdditional Payment Expected2012-06-26T00:00:002012-08-02T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2157Ins Co - Licensed/ActiveOrganizationINDV1216BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUsual And CustomaryNoNo Jurisdiction2012-06-15T00:00:002012-09-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG1217ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYConsumer (Non-Insured)Use of Credit ReportsNoInformation Furnished; Company Position Upheld2012-04-27T00:00:002012-08-09T00:00:00Property and CasualtyMiscellaneousNo Line SpecifiedAssociated Agent; Associated Subject Company936Ins Co - Licensed/ActiveOrganizationINDVCREDIT REPORT; UNDERWRITING CRITERIA1218UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDelays (Claims Handling)NoContract Language/Legal Issue; Information Furnished2012-06-13T00:00:002012-07-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV1219OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYProviderDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-06-29T00:00:002012-09-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDV1220STATE FARM LLOYDSInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Additional Payment Expected; Information Furnished2012-06-21T00:00:002012-08-13T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1221MEGA LIFE AND HEALTH INSURANCE COMPANY, THEInsuredDelays (Policyholder Service); Delays In AuthorizationNoInformation Furnished; Contract Language/Legal Issue2012-06-28T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2120Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1222TEXAS MEDICAID & HEALTHCARE PARTNERSHIPPhysicianDenial Of ClaimNoInformation Furnished; No Jurisdiction2012-06-12T00:00:002012-09-13T00:00:00Health Maintenance OrgAccident and HealthGroup A&H66518OtherOrganizationINDV1223SURETEC INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received; Claim Settled2012-06-29T00:00:002012-08-01T00:00:00Property and CasualtyMiscellaneousFidelity & Surety9138Ins Co - Licensed/ActiveOrganizationINDV1225ALLSTATE TEXAS LLOYD'SInsuredUnsatisfactory Settle/OfferNoAppraisal Process Invoked; Additional Payment Expected; Additional Monies Received2012-05-25T00:00:002012-08-15T00:00:00Property and CasualtyHomeownersHomeowners3721Ins Co - Licensed/ActiveOrganizationINDVAPPRAISAL; DAMAGE DISPUTE; DEPRECIATION; HAIL; ROOF1226UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of Claim; Timely Filing DeficiencyNoNo Jurisdiction2012-06-28T00:00:002012-08-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation1227HOMEOWNERS OF AMERICA INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoClaim Settled; Additional Monies Received2012-06-29T00:00:002012-08-22T00:00:00Property and CasualtyHomeownersHomeowners25247Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF1228FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-06-21T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person2623Injured EmployeeOrganizationINDVCOVERAGE DISPUTE1229BENEFIT ADMINISTRATION SERVICES, LTD.ProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-06-28T00:00:002012-09-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&H162277Third Party AdministratorsOrganizationINDV1230LOYA INSURANCE COMPANYThird PartyCust Service Claim Handling; Liability DisputeNoAdditional Payment Expected; Information Furnished2012-06-07T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass15643Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1231OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDelays (Claims Handling); Denial Of ClaimNoContract Language/Legal Issue; Additional Payment Expected2012-06-29T00:00:002012-08-22T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDV1232BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimYesStat Pen Pd-Over 90 Dys Late; Clean Claims Violation; Additional Monies Received2012-06-28T00:00:002012-08-30T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationINDV1233GARRISON PROPERTY AND CASUALTY INSURANCE COMPANYThird PartyDenial Of ClaimNoAdditional Monies Received; Contract Language/Legal Issue2012-06-29T00:00:002012-08-22T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1697Ins Co - Licensed/ActiveOrganizationINDV1234METROPOLITAN LLOYDS INSURANCE COMPANY OF TEXASInsuredUnsatisfactory Settle/OfferYesInformation Furnished; Question of Fact2012-06-29T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass3848Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN1235SOUTHERN COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and RatingNoQuestion of Fact; Contract Language/Legal Issue2012-05-31T00:00:002012-07-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass1583Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN1236NATIONWIDE MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Claim Settled; Additional Payment Expected2012-06-29T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1937Ins Co - Licensed/ActiveOrganizationINDVACV; APPRAISAL; GR-Claim Evaluation; TOTAL LOSS1238DRISCOLL CHILDREN'S HEALTH PLANProviderNot Within TDI Jurisdiction; OtherNoInformation Furnished; No Jurisdiction2012-06-29T00:00:002012-09-07T00:00:00Health Maintenance OrgAccident and HealthGroup A&HAssociated Subject Person12460Health Maintenance OrgOrganizationINDV1239SURETEC INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Question of Fact2012-06-29T00:00:002012-09-28T00:00:00Property and CasualtyMiscellaneousFidelity & Surety9138Ins Co - Licensed/ActiveOrganizationINDV1240STONEBRIDGE CASUALTY INSURANCE COMPANYInsuredDelays (Claims Handling); Denial Of ClaimYesInformation Furnished; Additional Monies Received2012-06-27T00:00:002012-09-27T00:00:00Property and CasualtyMiscellaneousTravel2267Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1241ALLSTATE COUNTY MUTUAL INSURANCE COMPANYInsuredOther; Premium and RatingYesInformation Furnished2012-06-06T00:00:002012-08-13T00:00:00Property and CasualtyAutomobileIndividual Private PassCorrespondent Person2228Ins Co - Licensed/ActiveOrganizationINDV1242OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredCancellationNoCompany Position Upheld2012-06-07T00:00:002012-10-04T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Associated Subject Person1823Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNDERWRITING CRITERIA1242PACHICANO, TRINIDADInsuredAgent Handling; Conversion; Delays (Claims Handling)YesReferred for Disciplinary Actn; Failure to Timely Respond2012-06-07T00:00:002012-10-04T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Associated Subject Person662788AgentIndividualINDVCOVERAGE DISPUTE; UNDERWRITING CRITERIA1243SOUTHERN COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished2012-06-21T00:00:002012-08-08T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1583Ins Co - Licensed/ActiveOrganizationINDVAFTERMARKET PARTS; SUPPLEMENTARY PAYMENT1244SCARBROUGH, MEDLIN & ASSOCIATES, INC.InsuredDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-06-08T00:00:002012-08-30T00:00:00Property and CasualtyHomeownersHomeowners Group6464Insurance AgencyOrganizationINDV1245STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredCancellationNoPolicy Issued/Restored; Information Furnished2012-06-29T00:00:002012-10-01T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV1246ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredAgent Handling; XX-Premiums MisquotedNoInformation Furnished2012-06-08T00:00:002012-07-16T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent936Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA1246HORNSBY, WES DEWAYNEInsuredXX-Coverage QuestionNo2012-06-08T00:00:002012-07-16T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent1132453AgentIndividualINDVUNDERWRITING CRITERIA1248UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoInformation Furnished2012-06-28T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation1250DIRECT GENERAL INSURANCE COMPANYInsuredCust Service Claim HandlingNoInformation Furnished; Additional Monies Received; Claim Settled2012-06-07T00:00:002012-08-09T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured20747Insurance AgencyOrganizationINDVADJUSTER'S HANDLING; SUPPLEMENTARY PAYMENT1251FOREMOST LLOYDS OF TEXASAgentUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-06-08T00:00:002012-07-23T00:00:00Property and CasualtyHomeownersHomeownersCorrespondent Person; Insured698Ins Co - Licensed/ActiveOrganizationINDVAPPRAISAL; DAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF1252BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONPhysicianDenial Of ClaimNoNo Jurisdiction2012-06-28T00:00:002012-08-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGBUNDLING; GR-Claim Evaluation; MATERNITY1253VOYAGER INDEMNITY INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCorrective Action Taken; Additional Payment Expected; Company Position Upheld2012-06-11T00:00:002012-08-08T00:00:00Property and CasualtyHomeownersHomeowners66745Ins Co - Surplus LinesOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; DEDUCTIBLE; DEPRECIATION; GR-Claim Evaluation; MOLD; ROOF1255ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredDelays (Policyholder Service); Refund Of PremiumNoContract Language/Legal Issue2012-06-11T00:00:002012-08-08T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDV1255MOORE, DANIEL RUSSELLInsuredAgent HandlingNoContract Language/Legal Issue2012-06-11T00:00:002012-08-08T00:00:00Property and CasualtyAutomobileIndividual Private Pass725128AgentIndividualINDV1256MEPCOInsuredMisrepresentationNoInsufficient Information2012-06-11T00:00:002012-09-12T00:00:00Property and CasualtyMiscellaneousNo Line Specified66747OtherOrganizationINDV1258ALLSTATE INSURANCE COMPANYInsuredOtherNoNo Jurisdiction2012-06-11T00:00:002012-08-01T00:00:00Property and CasualtyMiscellaneousFederal Flood168Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA1260SAFECO INSURANCE COMPANY OF INDIANAOtherUnsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished2012-06-11T00:00:002012-08-16T00:00:00Property and CasualtyHomeownersHomeownersInsured2496Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; OVERHEAD AND PROFIT1261Bank of America Home LoansInsuredRefund Of PremiumNoInformation Furnished; Company Position Upheld2012-06-11T00:00:002012-08-16T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency66751Mortgage LenderOrganizationINDV1262HUMANA INSURANCE COMPANYInsuredDelays (Policyholder Service)NoInformation Furnished2012-06-14T00:00:002012-08-01T00:00:00Life, Accident and HealthAccident and HealthXX-State Specific1040Ins Co - Licensed/ActiveOrganizationINDV1263STATE FARM LLOYDSInsuredUnsatisfactory Settle/OfferNo2012-06-07T00:00:002012-08-20T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDV1263SLOAN CLARK INSURANCEInsuredCust Service Claim HandlingNoCompany Position Upheld; Information Furnished2012-06-07T00:00:002012-08-20T00:00:00Property and CasualtyHomeownersHomeowners66756Insurance AgencyOrganizationINDV1264LIFE INSURANCE COMPANY OF NORTH AMERICARelativeDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-06-13T00:00:002012-08-30T00:00:00Life, Accident and HealthLife & AnnuityGroup LifeInsured2157Ins Co - Licensed/ActiveOrganizationINDV1265UNUM LIFE INSURANCE COMPANY OF AMERICAInsuredDenial Of ClaimNoAdditional Payment Expected; Information Furnished; Contract Language/Legal Issue2012-06-14T00:00:002012-08-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1327Ins Co - Licensed/ActiveOrganizationINDV1266GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredDenial Of ClaimNoAdditional Payment Expected; Information Furnished; Question of Fact2012-07-09T00:00:002012-12-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVACV; GR-Claim Evaluation1267STATE FARM LIFE INSURANCE COMPANYInsuredPremium and RatingNoContract Language/Legal Issue; Information Furnished2012-06-14T00:00:002012-08-10T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1509Ins Co - Licensed/ActiveOrganizationINDV1269BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-06-12T00:00:002012-08-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG1270GEICO ADVANTAGE INSURANCE COMPANYInsuredOtherNoInformation Furnished2012-06-29T00:00:002012-10-09T00:00:00Property and CasualtyAutomobileIndividual Private Pass63856Ins Co - Licensed/ActiveOrganizationINDV1271PACIFIC SPECIALTY PROPERTY AND CASUALTY COMPANYInsuredCancellationNoPolicy Issued/Restored; Information Furnished2012-06-11T00:00:002012-07-26T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent15084Ins Co - Licensed/ActiveOrganizationINDV1271SU UNICA INSURANCE PARTNERS LIMITED LIABILITY COMPANYInsuredAgent Handling; ConversionYesReferred for Disciplinary Actn; Information Furnished2012-06-11T00:00:002012-07-26T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent63671Insurance AgencyOrganizationINDV1272TEXAS MUTUAL INSURANCE COMPANYOtherOtherYesOther2012-06-26T00:00:002012-12-04T00:00:00Property and CasualtyMiscellaneousWorkers' Compensation3500Ins Co - Licensed/ActiveOrganizationORG1273DRIVER'S INSURANCE COMPANYInsuredPremium and RatingYesInformation Furnished2012-06-25T00:00:002012-08-17T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company2038Ins Co - Licensed/ActiveOrganizationINDV1274BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONPhysicianDelays (Claims Handling)NoInsufficient Information2012-06-28T00:00:002012-11-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV1275TRAVELERS LLOYDS OF TEXAS INSURANCE COMPANYInsuredExcessive Rates; Premium and RatingNoInformation Furnished2012-06-12T00:00:002012-08-14T00:00:00Property and CasualtyHomeownersHomeowners776Ins Co - Licensed/ActiveOrganizationINDV1276GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredOtherNoNo Jurisdiction2012-06-25T00:00:002012-08-02T00:00:00Property and CasualtyMiscellaneousNo Line Specified2486Ins Co - Licensed/ActiveOrganizationINDV1277GARRISON PROPERTY AND CASUALTY INSURANCE COMPANYInsuredCancellation; Denial Of ClaimNoQuestion of Fact; Company Position Upheld2012-06-11T00:00:002012-08-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass1697Ins Co - Licensed/ActiveOrganizationINDV1277Guzik, Natalie MarieInsuredOtherYesReferred for Disciplinary Actn2012-06-11T00:00:002012-08-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass1130253OtherIndividualINDV1278JOHN ALDEN LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished2012-06-28T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured2495Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1278CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUsual And CustomaryNoNo Jurisdiction; Information Furnished2012-06-28T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured2851Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1279DRIVER'S INSURANCE COMPANYInsuredDelays (Claims Handling); Delays (Policyholder Service)YesInformation Furnished; Additional Monies Received2012-06-11T00:00:002012-08-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1281TRUSTMARK LIFE INSURANCE COMPANYAgentUnsatisfactory Settle/Offer; Usual And CustomaryNoInformation Furnished; No Jurisdiction2012-06-14T00:00:002012-09-26T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured2732Ins Co - Licensed/ActiveOrganizationINDV1282GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished2012-06-11T00:00:002012-08-14T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1283ALLSTATE TEXAS LLOYD'SInsuredRefund Of PremiumNoAdditional Monies Received2012-06-29T00:00:002012-08-29T00:00:00Property and CasualtyHomeownersRentalAssociated Subject Agency3721Ins Co - Licensed/ActiveOrganizationINDV1284CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-06-28T00:00:002012-08-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORG1285HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredCancellation; Denial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-06-29T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass2362Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF1286CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling); SB418 Rule ViolationYesStat Pen Pd-Over 90 Dys Late; Additional Monies Received; Clean Claims Violation2012-06-14T00:00:002012-07-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORG1287HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredAgent Handling; Delays (Claims Handling)NoContract Language/Legal Issue; Information Furnished2012-06-25T00:00:002012-10-22T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency; Associated Subject Company2362Ins Co - Licensed/ActiveOrganizationINDV1287SENCHAL, TAMI MACHELLEInsuredAgent HandlingNoQuestion of Fact; Information Furnished2012-06-25T00:00:002012-10-22T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency; Associated Subject Company293833AgentIndividualINDV1288ALLSTATE INDEMNITY COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling)NoClaim Settled; Information Furnished2012-06-29T00:00:002012-11-29T00:00:00Property and CasualtyAutomobileIndividual Private Pass167Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1289CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDenial Of ClaimNo2012-06-14T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORG1289SAMBA Health Benefit PlanProviderDenial Of ClaimNoNo Jurisdiction2012-06-14T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured67366Govermental EntityOrganizationORG1290AETNA LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoClaim Settled2012-07-02T00:00:002012-08-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDV1291RANCHERS AND FARMERS MUTUAL INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling)NoInformation Furnished; Company Position Upheld2012-06-20T00:00:002012-08-09T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company; Associated Subject Person1689Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; BURDEN OF PROOF; COVERAGE DISPUTE; DAMAGE DISPUTE; POLICY EXCLUSION; ROOF1292TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished2012-06-29T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass1450Ins Co - Licensed/ActiveOrganizationINDV1293NATIONAL LLOYDS INSURANCE COMPANYInsuredCancellation; Delays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld2012-06-12T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners1914Ins Co - Licensed/ActiveOrganizationINDV1294INFINITY COUNTY MUTUAL INSURANCE COMPANYThird PartyLiability DisputeYesAdditional Monies Received2012-06-12T00:00:002012-07-23T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1197Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE1295CONSECO LIFE INSURANCE COMPANYInsuredDelays (Policyholder Service); Refund Of PremiumNoAdditional Payment Expected; Contract Language/Legal Issue2012-05-20T00:00:002012-08-07T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2113Ins Co - Licensed/ActiveOrganizationINDV1296UNITEDHEALTHCARE INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Additional Monies Received2012-06-14T00:00:002012-08-08T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV1297STATE FARM LLOYDSInsuredCancellationNoInformation Furnished2012-06-29T00:00:002012-09-06T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA1298ENCOMPASS INDEMNITY COMPANYInsuredDelays (Claims Handling)YesInformation Furnished; Additional Payment Expected2012-06-25T00:00:002012-09-06T00:00:00Property and CasualtyAutomobileIndividual Private Pass15014Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1299NATIONAL PACIFIC DENTAL, INC.InsuredUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-06-14T00:00:002012-09-19T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured Company3669Single Service HmoOrganizationINDV1300TEXAS FARMERS INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-06-29T00:00:002012-08-26T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent1452Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNDERWRITING CRITERIA1301ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimYesInformation Furnished2012-06-29T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDV1302FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue; Additional Payment Expected2012-06-25T00:00:002012-08-29T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2623Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1303COMMUNITY FIRST HEALTH PLANS, INC.ProviderDenial Of ClaimNoNo Jurisdiction2012-06-14T00:00:002012-10-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured12210Ins Co - Licensed/ActiveOrganizationORG1305HORACE MANN PROPERTY & CASUALTY INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received2012-06-12T00:00:002012-08-01T00:00:00Property and CasualtyAutomobileIndividual Private Pass1734Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; GR-Claim Evaluation; TOTAL LOSS1306STATE FARM LLOYDSInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Company Position Upheld2012-06-25T00:00:002012-08-06T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation1307OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDenial Of ClaimNoPolicy Not In Force; Company Position Upheld2012-06-29T00:00:002012-08-22T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDV1308HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredOtherNoInformation Furnished2012-06-15T00:00:002012-07-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass2362Ins Co - Licensed/ActiveOrganizationINDV1309WELLCARE OF TEXAS, INC.PhysicianDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-06-15T00:00:002012-08-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person; Insured28079Health Maintenance OrgOrganizationINDV1310METROPOLITAN LLOYDS INSURANCE COMPANY OF TEXASOtherCust Service Claim Handling; Unsatisfactory Settle/OfferYesAdditional Payment Expected; Claim Settled2012-06-12T00:00:002012-09-11T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person; Insured3848Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; ENGINEER'S REPORT; GR-Claim Evaluation; HAIL; MOLD; ROOF; SUPPLEMENTARY PAYMENT1311GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyDenial Of ClaimYesCompany Position Upheld; Information Furnished2012-06-25T00:00:002012-08-29T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation1312INFINITY COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of Claim; Unsatisfactory Settle/OfferYesInformation Furnished; Claim Settled; Additional Payment Expected2012-06-12T00:00:002012-08-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass1197Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1313PRINCIPAL LIFE INSURANCE COMPANYProviderDenial Of ClaimNoContract Language/Legal Issue2012-06-14T00:00:002012-11-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person; Insured3032Ins Co - Licensed/ActiveOrganizationINDV1314LIBERTY COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld2012-06-25T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured3762Ins Co - Licensed/ActiveOrganizationINDV1315MID-CENTURY INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Payment Expected; Information Furnished; Company Position Upheld2012-06-29T00:00:002012-08-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass2085Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1316BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-06-28T00:00:002012-08-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1317HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished2012-06-11T00:00:002012-08-09T00:00:00Property and CasualtyAutomobileIndividual Private Pass2362Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE1318ZURICH AMERICAN INSURANCE COMPANYAttorneyDelays (Claims Handling)NoCompany Position Upheld; Information Furnished; Additional Payment Expected2012-06-29T00:00:002012-08-16T00:00:00Property and CasualtyLiabilityGeneral LiabilityAssociated Subject Person; Correspondent Person; Insured Company10087Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1319SANTA FE AUTO INSURANCE COMPANYInsuredOtherNoInformation Furnished2012-06-13T00:00:002012-07-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass27766Ins Co - Licensed/ActiveOrganizationINDV1320PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYProviderDelays (Claims Handling)NoClaim Settled; Additional Monies Received2012-06-25T00:00:002012-09-14T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationORG1321GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredUse Of Clue ReportsNoCorrective Action Taken; Information Furnished2012-06-25T00:00:002012-08-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1323UNIVERSAL NORTH AMERICA INSURANCE COMPANYInsuredNon-RenewalNoCompany Position Upheld; Information Furnished2012-06-12T00:00:002012-08-01T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent23526Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNDERWRITING CRITERIA1324INFINITY COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished2012-06-11T00:00:002012-07-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass1197Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1325AETNA LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-06-29T00:00:002012-08-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG1326FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Policyholder Service); Premium NoticeYesPremium Refunded2012-06-25T00:00:002012-08-20T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Associated Subject Person2623Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN1327NATIONAL LLOYDS INSURANCE COMPANYInsuredDelays (Claims Handling)YesAdditional Monies Received2012-06-12T00:00:002012-08-10T00:00:00Property and CasualtyHomeownersRental1914Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1328ESURANCE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoAdditional Payment Expected; Information Furnished2012-06-13T00:00:002012-07-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass1350Ins Co - Licensed/ActiveOrganizationINDVACV; APPRAISAL; GR-Claim Evaluation; TOTAL LOSS1329STATE FARM LLOYDSInsuredDenial Of Claim; Unsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-06-29T00:00:002012-08-27T00:00:00Property and CasualtyHomeownersHomeownersCorrespondent Company3105Ins Co - Licensed/ActiveOrganizationINDVAPPRAISAL; DAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF; WATER DAMAGE1330PRESTON, ELIZABETH ANNEInsuredAgent HandlingNoInformation Furnished2012-06-20T00:00:002012-08-07T00:00:00Life, Accident and HealthLife & AnnuityCredit LifeAssociated Agent346053AgentIndividualINDV1331ELEPHANT INSURANCE COMPANYOtherDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-06-12T00:00:002012-07-26T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured52783Ins Co - Licensed/ActiveOrganizationINDV1332AMERICAN GENERAL LIFE INSURANCE COMPANYBeneficiaryDelays (Claims Handling)NoInformation Furnished; Complainant Retained Attorney2012-06-29T00:00:002012-09-17T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured152Ins Co - Licensed/ActiveOrganizationINDV1333PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredRefusal to InsureNoCompany Position Upheld2012-06-25T00:00:002012-10-11T00:00:00Property and CasualtyFire, Allied Lines & CMPXX-Commercial Multi-Peril1708Ins Co - Licensed/ActiveOrganizationORG1333GRICE, RICHARD HInsuredAgent Handling; MisrepresentationYesInformation Furnished2012-06-25T00:00:002012-10-11T00:00:00Property and CasualtyFire, Allied Lines & CMPXX-Commercial Multi-Peril520977AgentIndividualORG1334GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; Company Position Upheld2012-06-12T00:00:002012-08-08T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE1335LIFE INSURANCE COMPANY OF NORTH AMERICAInsuredDenial Of ClaimYesQuestion of Fact2012-03-29T00:00:002012-11-02T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2157Ins Co - Licensed/ActiveOrganizationINDV1336OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)YesCorrective Action Taken; Additional Payment Expected2012-06-25T00:00:002012-09-04T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDV1337LIBERTY MUTUAL FIRE INSURANCE COMPANYInsuredOtherYesInformation Furnished; Corrective Action Taken2012-06-29T00:00:002012-10-17T00:00:00Property and CasualtyHomeownersHomeowners2209Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation1338PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and RatingNoCompany Position Upheld2012-06-29T00:00:002012-09-05T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDV1340ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Company Position Upheld2012-07-02T00:00:002012-09-10T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured936Ins Co - Licensed/ActiveOrganizationINDV1340STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyAssignment of BenefitsNoCompany Position Upheld; Information Furnished2012-07-02T00:00:002012-09-10T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured1510Ins Co - Licensed/ActiveOrganizationINDV1341CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANYProviderDenial Of Claim; Unsatisfactory Settle/OfferNoNo Jurisdiction; Additional Monies Received; Information Furnished2012-06-29T00:00:002012-09-06T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person; Insured25422Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN1342ALTERRA EXCESS & SURPLUS INSURANCE COMPANYInsuredDelays (Claims Handling)NoAdditional Payment Expected; Company Position Upheld2012-06-11T00:00:002012-08-29T00:00:00Property and CasualtyMiscellaneousP & C Misc48727Ins Co - Surplus LinesOrganizationORGGR-Claim Evaluation1343PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-06-29T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileBusiness Automobile1708Ins Co - Licensed/ActiveOrganizationINDV1345HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredCancellation; Refund Of PremiumNoInformation Furnished; Premium Refunded2012-06-13T00:00:002012-07-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass2362Ins Co - Licensed/ActiveOrganizationINDV1346STATE FARM LLOYDSThird PartyUnsatisfactory Settle/OfferYesAdditional Monies Received; Information Furnished2012-06-25T00:00:002012-09-10T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent; Insured3105Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation; HAIL; ROOF; SUPPLEMENTARY PAYMENT; WATER DAMAGE1347OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeNoQuestion of Fact2012-06-28T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Associated Subject Person; Insured1823Ins Co - Licensed/ActiveOrganizationINDV1348ASI LLOYDSThird PartyDenial Of ClaimNoClaim Settled; Additional Monies Received; Information Furnished2012-06-12T00:00:002012-08-16T00:00:00Property and CasualtyHomeownersHomeownersInsured14728Ins Co - Licensed/ActiveOrganizationINDV1349ALLSTATE TEXAS LLOYD'SInsuredDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-06-29T00:00:002012-09-10T00:00:00Property and CasualtyHomeownersHomeowners3721Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; DAMAGE DISPUTE; GR-Claim Evaluation; UNDERWRITING CRITERIA; WATER DAMAGE1350TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredUnsatisfactory Settle/OfferNoInformation Furnished2012-07-02T00:00:002012-11-12T00:00:00Property and CasualtyHomeownersHomeowners1444Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE1350CUELLAR, MANUEL JRInsuredConversionYesReferred for Disciplinary Actn2012-07-02T00:00:002012-11-12T00:00:00Property and CasualtyHomeownersHomeowners304081AgentIndividualINDVDEDUCTIBLE1351OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished2012-07-02T00:00:002012-08-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1352GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-07-02T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1353UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-07-02T00:00:002012-08-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG1354ARCH INSURANCE COMPANYAttorneyDelays (Claims Handling); Liability DisputeNoInformation Furnished; Company Position Upheld2012-06-21T00:00:002012-09-19T00:00:00Property and CasualtyLiabilityXX-GeneralAssociated Agent625Ins Co - Licensed/ActiveOrganizationINDV1355AETNA DENTAL INC.InsuredDelays (Claims Handling)YesInsufficient Information2012-07-02T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company3533Health Maintenance OrgOrganizationINDVGR-Claim Evaluation1356OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYConsumer (Non-Insured)Delays (Claims Handling)NoInformation Furnished; Additional Payment Expected2012-07-02T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured; Third Party Admin-Non Licensed1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; TOTAL LOSS1357TEXAS HEALTHSPRING, LLCProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-02T00:00:002012-08-28T00:00:00Medicare Managed Care for HMOAccident and HealthIndividual A & HAssociated Subject Company; Insured18634Health Maintenance OrgOrganizationORGGR-Claim Evaluation1359RELIABLE LIFE INSURANCE COMPANY, THEInsuredCash ValueYesAdditional Payment Expected2012-07-02T00:00:002012-08-29T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1704Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1360STANDARD FIRE INSURANCE COMPANY, THEInsuredDenial Of ClaimNoCancel/Non-Renewal Upheld; Information Furnished2012-06-29T00:00:002012-09-28T00:00:00Property and CasualtyHomeownersHomeowners1493Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; HAIL; ROOF; UNDERWRITING CRITERIA1360A R SCHELL & SON AGENCY INInsuredPremium NoticeNoInformation Furnished; Company Position Upheld2012-06-29T00:00:002012-09-28T00:00:00Property and CasualtyHomeownersHomeowners11931AgentOrganizationINDVCOVERAGE DISPUTE; HAIL; ROOF; UNDERWRITING CRITERIA1361UNITED HEALTHCARE SERVICESProviderOtherNoNo Jurisdiction2012-07-02T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured24581OtherOrganizationINDV1361UNITED BEHAVIORAL HEALTHProviderOtherNo2012-07-02T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured44243Third Party AdministratorsOrganizationINDV1362BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONConsumer (Non-Insured)Prompt PayNoInformation Furnished; Claim Not Clean2012-07-10T00:00:002012-08-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG1365AMERIGROUP TEXAS, INC.ProviderDenial Of ClaimNoInformation Furnished; No Jurisdiction2012-07-02T00:00:002012-08-20T00:00:00Medicare HMOAccident and HealthIndividual A & HInsured8032Health Maintenance OrgOrganizationINDV1366OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Payment Expected; Information Furnished2012-07-02T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDV1367ASI LLOYDSInsuredDelays (Claims Handling)NoClaim Settled; Company Position Upheld; Information Furnished2012-07-02T00:00:002012-08-27T00:00:00Property and CasualtyHomeownersHomeowners14728Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1368GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Additional Payment Expected2012-07-04T00:00:002012-07-31T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent2486Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; SENIOR CITIZEN1369UNITEDHEALTHCARE OF TEXAS, INC.ProviderDenial Of ClaimNoInformation Furnished; No Jurisdiction2012-06-29T00:00:002012-11-07T00:00:00Medicare HMOAccident and HealthIndividual A & HCorrespondent Person; Insured3363Health Maintenance OrgOrganizationORGGR-Claim Evaluation1370UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-07-02T00:00:002012-08-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured; Third Party Admin-Licensed1348Ins Co - Licensed/ActiveOrganizationINDV1371STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredRefund Of PremiumYesPremium Refunded; Information Furnished; Additional Monies Received2012-06-11T00:00:002012-07-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV1372OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYLienholderDelays (Claims Handling)NoCompany Position Upheld; Information Furnished2012-06-29T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1373PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredOther; Unsatisfactory Settle/OfferNoCompany Position Upheld2012-04-20T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDV1374USAA CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-07-02T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass3607Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED1375PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoQuestion of Fact2012-07-02T00:00:002012-11-29T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1376PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished2012-06-11T00:00:002012-07-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; TOTAL LOSS1377UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)YesInformation Furnished; Additional Monies Received; Corrective Action Taken2012-07-02T00:00:002012-11-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person; Insured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation1379PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of Claim; Liability DisputeNoCompany Position Upheld; Information Furnished; Entered Into Arbitration2012-07-02T00:00:002012-08-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDV1379AMICA MUTUAL INSURANCE COMPANYInsuredLiability DisputeNoInformation Furnished; Company Position Upheld; Entered Into Arbitration2012-07-02T00:00:002012-08-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass3532Ins Co - Licensed/ActiveOrganizationINDV1380FIRST HEALTH/TRAVELERS HCNProviderUnsatisfactory Settle/OfferYesAdditional Monies Received2012-06-26T00:00:002012-10-31T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkInsured54191WC Healthcare Provider NtwkOrganizationORG1381HUMANA INSURANCE COMPANYProviderDelays (Claims Handling); Denial Of ClaimNoNo Jurisdiction2012-06-29T00:00:002012-08-01T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1040Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN1382STATE FARM LLOYDSInsuredPremium and RatingNoInformation Furnished2012-07-02T00:00:002012-09-26T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN1383GRAMERCY INSURANCE COMPANYAttorneyDelays (Claims Handling)YesClaim Settled; Information Furnished2012-07-02T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileBusiness AutomobileAssociated Subject Company; Associated Subject Person1062Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING1384PRIORITY ONE INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld2012-06-29T00:00:002012-10-30T00:00:00Property and CasualtyHomeownersHomeowners1123Ins Co - Licensed/ActiveOrganizationINDVROOF; SENIOR CITIZEN; WATER DAMAGE1384R.V.O.S. FARM MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld2012-06-29T00:00:002012-10-30T00:00:00Property and CasualtyHomeownersHomeowners2621Ins Co - Licensed/ActiveOrganizationINDVROOF; SENIOR CITIZEN; WATER DAMAGE1386ROOFKING, LLCConsumer (Non-Insured)MisrepresentationNoInformation Furnished2012-06-11T00:00:002012-10-31T00:00:00Property and CasualtyHomeownersHomeowners66799OtherOrganizationINDV1387STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXASInsuredPremium and RatingNoInformation Furnished; Company Position Upheld2012-07-02T00:00:002012-08-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass1506Ins Co - Licensed/ActiveOrganizationINDV1388Gabriel, MichaelConsumer (Non-Insured)OtherNoInsufficient Information2012-06-25T00:00:002012-09-19T00:00:00Property and CasualtyMiscellaneousP & C Misc1130454OtherIndividualINDV1389ARNOLD, JEFFREY CConsumer (Non-Insured)Agent HandlingYesInformation Furnished2012-06-11T00:00:002012-08-09T00:00:00Property and CasualtyLiabilityGeneral LiabilityAssociated Agent386742AgentIndividualINDV1390STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYRelativeDelays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld2012-07-02T00:00:002012-09-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV1391BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONRelativeBalance Billing; Medical Necessity; Out Of Ntwk Referral; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-02T00:00:002012-09-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Utilization Review Agent10047Ins Co - Licensed/ActiveOrganizationINDVEMERGENCY CARE1392UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesStat Pen Pd-46 To 90 Dys Late; Additional Monies Received; Information Furnished2012-07-02T00:00:002012-09-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG1393BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUsual And CustomaryNoInformation Furnished; Contract Language/Legal Issue2012-06-14T00:00:002012-08-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG1396TEXAS FARM BUREAU CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling)YesInformation Furnished; Additional Payment Expected; Corrective Action Taken2012-07-02T00:00:002012-09-12T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person28440Ins Co - Licensed/ActiveOrganizationINDV1398GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredExcessive Rates; Premium and RatingYesCorrective Action Taken; Information Furnished2012-07-02T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA1399ACCC INSURANCE COMPANYAttorneyDenial Of ClaimYesAdditional Payment Expected; Information Furnished; Company Position Upheld2012-07-03T00:00:002012-09-14T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1400AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished2012-07-02T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationORGMULTIPLE INSUREDS1401Texas Star Network WCNInsuredCust Service Claim HandlingNoInformation Furnished2012-06-04T00:00:002012-07-31T00:00:00Workers Compensation NetworkAccident and HealthGroup A&HAssociated Subject Company67191WC Healthcare Provider NtwkOrganizationINDV1402BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished2012-07-02T00:00:002012-08-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationORGMULTIPLE INSUREDS1403OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYLienholderDenial Of ClaimNoEntered in Error2012-07-03T00:00:002012-08-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDV1404HARTFORD LIFE AND ACCIDENT INSURANCE COMPANYInsuredOtherNoContract Language/Legal Issue2012-06-15T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2383Ins Co - Licensed/ActiveOrganizationINDV1405INFINITY COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld; Information Furnished2012-07-02T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass1197Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1406UNITEDHEALTHCARE INSURANCE COMPANYInsuredMedical Necessity; Unsatisfactory Settle/OfferYesAdditional Monies Received2012-06-29T00:00:002012-09-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDVEMERGENCY CARE; GR-Claim Evaluation1407WESTCHESTER SURPLUS LINES INSURANCE COMPANYThird PartyDelays (Policyholder Service)NoInformation Furnished; Contract Language/Legal Issue2012-07-03T00:00:002012-08-16T00:00:00Property and CasualtyHomeownersCondominiumAssociated Subject Company; Associated Subject Person; Insured Company48858Ins Co - Surplus LinesOrganizationINDV1408TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferYesInformation Furnished; Additional Payment Expected2012-07-03T00:00:002012-09-26T00:00:00Property and CasualtyHomeownersHomeowners1450Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; ROOF1409OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)YesClaim Settled2012-06-20T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileXX-Private Passenger Group1823Ins Co - Licensed/ActiveOrganizationINDV1410WESCO INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoAdditional Monies Received2012-05-16T00:00:002012-08-02T00:00:00Life, Accident and HealthAutomobileIndividual Private Pass1200Ins Co - Licensed/ActiveOrganizationINDV1412OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYLienholderDenial Of ClaimNoContract Language/Legal Issue2012-07-03T00:00:002012-08-20T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Person; Insured1823Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1413STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoCompany Position Upheld; Information Furnished2012-07-03T00:00:002012-08-31T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; UNCOOPERATIVE INSURED1414ALFA VISION INSURANCE CORPORATIONConsumer (Non-Insured)Denial Of ClaimNoPolicy Not In Force; Information Furnished2012-07-02T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured22105Ins Co - Licensed/ActiveOrganizationORGPOLICY EXCLUSION1415AMERICAN BANKERS INSURANCE COMPANY OF FLORIDAInsuredDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-07-03T00:00:002012-09-17T00:00:00Property and CasualtyHomeownersHomeowners176Ins Co - Licensed/ActiveOrganizationINDVHAIL; ROOF1416AMERICAN ACCESS CASUALTY COMPANYInsuredDelays (Claims Handling)YesAdditional Monies Received; Additional Payment Expected; Information Furnished2012-07-03T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass30332Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; LOSS OF USE1417Jackson Abstract & Title CompanyConsumer (Non-Insured)Delays (Policyholder Service)NoPolicy Issued/Restored2012-06-26T00:00:002012-07-25T00:00:00Property and CasualtyMiscellaneousTitle Insurance66813Insurance AgencyOrganizationINDV1418OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYConsumer (Non-Insured)Delays (Claims Handling); Unsatisfactory Settle/OfferYesInformation Furnished; Additional Payment Expected2012-07-02T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private PassAlias Name1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; REPLACEMENT VEHICLE1419UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-07-02T00:00:002012-10-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Self-Funded / ErisaOrganizationORGMULTIPLE INSUREDS1420DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-07-03T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass2038Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1421AETNA LIFE INSURANCE COMPANYProviderAssignment of BenefitsNoInformation Furnished; Company Position Upheld2012-06-20T00:00:002013-01-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationORG1422UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling); Unsatisfactory Settle/OfferNoContract Language/Legal Issue2012-06-25T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company; Insured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation1423STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received2012-07-03T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Associated Subject Person1510Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1424GEICO INDEMNITY COMPANYInsuredDenial Of Claim; Unsatisfactory Settle/OfferNoOther; Question of Fact2012-06-18T00:00:002012-08-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass2785Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; HAIL1425SAFECO INSURANCE COMPANY OF AMERICAThird PartyDelays (Claims Handling)YesComplainant Retained Attorney; Additional Payment Expected; Information Furnished2012-07-03T00:00:002012-09-12T00:00:00Property and CasualtyMiscellaneousFidelity & SuretyAssociated Subject Company; Insured Company1619Ins Co - Licensed/ActiveOrganizationINDV1426BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-07-02T00:00:002012-08-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGBUNDLING; GR-Claim Evaluation; MULTIPLE INSUREDS1427STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferYesInformation Furnished2012-06-07T00:00:002012-08-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; DIMINISHED VALUE; GR-Claim Evaluation1428NATIONWIDE MUTUAL INSURANCE COMPANYInsuredDelays (Policyholder Service)NoPremium Refunded2012-06-18T00:00:002012-10-18T00:00:00Property and CasualtyAutomobileBusiness Automobile1937Ins Co - Licensed/ActiveOrganizationINDV1428DO, LEE KInsuredDelays (Policyholder Service)Yes2012-06-18T00:00:002012-10-18T00:00:00Property and CasualtyAutomobileBusiness Automobile30591AgentIndividualINDV1429LIBERTY COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoAdditional Payment Expected; Question of Fact; Company Position Upheld2012-06-22T00:00:002012-08-22T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured3762Ins Co - Licensed/ActiveOrganizationINDVDIMINISHED VALUE; GR-Claim Evaluation1430Blue Star TitleInsuredClosed-Lack Of Info CmplainantNoOther2012-07-03T00:00:002012-08-29T00:00:00Property and CasualtyMiscellaneousTitle Insurance66822OtherOrganizationINDV1430Aqua TexasInsuredNot Within TDI JurisdictionNoNo Jurisdiction2012-07-03T00:00:002012-08-29T00:00:00Property and CasualtyMiscellaneousTitle Insurance66825OtherOrganizationINDV1431TIME INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-07-02T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company; Insured1374Ins Co - Licensed/ActiveOrganizationORG1432OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Payment Expected; Information Furnished2012-07-03T00:00:002012-08-23T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDV1433TEXAS FARMERS INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld; Information Furnished2012-07-03T00:00:002012-08-28T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE; GR-Claim Evaluation; HAIL; ROOF1434SOUTHWEST LIFE & HEALTH INSURANCE COMPANYAgentCust Service Claim HandlingNoInformation Furnished2012-06-06T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2041Ins Co - Licensed/ActiveOrganizationINDV1435ACCC INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-07-04T00:00:002012-08-29T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured9825Ins Co - Licensed/ActiveOrganizationINDVLOSS OF USE; TOTAL LOSS1436PREXISTING CONDITION INSURANCE PLANProviderNot Within TDI JurisdictionNoNo Jurisdiction2012-07-10T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured67816Govermental EntityOrganizationORGGR-Claim Evaluation1437AMERICAN BANKERS INSURANCE COMPANY OF FLORIDAInsuredNon-Disclosure Of Coverage; Refund Of PremiumNoOther; Information Furnished2012-07-02T00:00:002012-08-30T00:00:00Property and CasualtyMiscellaneousP & C MiscAssociated Subject Agency; Associated Subject Company176Ins Co - Licensed/ActiveOrganizationINDV1439LIBERTY COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled; Information Furnished; Additional Payment Expected2012-07-03T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private Pass3762Ins Co - Licensed/ActiveOrganizationINDV1440TRINITY UNIVERSAL INSURANCE COMPANYInsuredDenial Of Claim; Unsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-07-03T00:00:002012-08-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass1353Ins Co - Licensed/ActiveOrganizationINDVAPPRAISAL; BETTERMENT; COVERAGE DISPUTE1441GERMANIA FARM MUTUAL INSURANCE ASSOCIATIONOtherDenial Of Claim; Unsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-07-04T00:00:002012-09-12T00:00:00Property and CasualtyHomeownersHomeowners2468Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF1442STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredDelays (Claims Handling)YesClaim Settled; Information Furnished2012-06-25T00:00:002012-08-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1443UNITEDHEALTHCARE INSURANCE COMPANYRelativeDelays (Claims Handling)YesCompany Position Upheld2012-06-21T00:00:002012-09-13T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company1348Ins Co - Licensed/ActiveOrganizationINDV1444ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld2012-07-05T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured936Ins Co - Licensed/ActiveOrganizationORG1445HARTFORD INSURANCE COMPANY OF THE MIDWESTThird PartyDelays (Claims Handling)YesCorrective Action Taken; Information Furnished2012-07-05T00:00:002012-08-29T00:00:00Property and CasualtyAutomobileBusiness AutomobileAssociated Subject Company; Insured Company650Ins Co - Licensed/ActiveOrganizationINDV1447WOODMEN OF THE WORLD LIFE INSURANCE SOCIETYRelativeOtherNoOther2012-06-21T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company1186Ins Co - Licensed/ActiveOrganizationINDV1448UNITED SERVICES AUTOMOBILE ASSOCIATIONOtherXX-SubrogationNoInformation Furnished2012-07-03T00:00:002012-11-02T00:00:00Property and CasualtyAutomobileIndividual Private Pass1254Ins Co - Licensed/ActiveOrganizationINDV1448USAA CASUALTY INSURANCE COMPANYOtherXX-SubrogationNo2012-07-03T00:00:002012-11-02T00:00:00Property and CasualtyAutomobileIndividual Private Pass3607Ins Co - Licensed/ActiveOrganizationINDV1449CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-02T00:00:002012-08-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation1450UNDERWRITERS AT LLOYD'S, LONDONInsuredPremium and RatingNoCompany Position Upheld; Information Furnished2012-06-25T00:00:002012-08-30T00:00:00Property and CasualtyHomeownersHomeowners55949Ins Co - Licensed/ActiveOrganizationINDV1452FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and Rating; Refund Of PremiumNoInformation Furnished2012-07-05T00:00:002012-08-28T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent2623Ins Co - Licensed/ActiveOrganizationINDV1453UNITED SERVICES AUTOMOBILE ASSOCIATIONThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Question of Fact2012-06-25T00:00:002012-08-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass1254Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation1454BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDelays (Policyholder Service)NoAdditional Monies Received; Information Furnished2012-06-08T00:00:002012-08-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV1456BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of Claim; Usual And CustomaryNoNo Jurisdiction; Contract Language/Legal Issue2012-06-27T00:00:002012-08-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation1457HOME STATE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Claim Settled2012-07-02T00:00:002012-08-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured2362Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1458STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDenial Of ClaimYesAdditional Payment Expected; Information Furnished2012-07-05T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1459STARR INDEMNITY & LIABILITY COMPANYInsuredDenial Of Claim; Pre-Existing ConditionNoInformation Furnished; Contract Language/Legal Issue2012-06-25T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&H997Ins Co - Licensed/ActiveOrganizationINDV1461BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of Claim; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-06-27T00:00:002012-08-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation1462ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; Company Position Upheld; Information Furnished2012-07-02T00:00:002012-08-31T00:00:00Property and CasualtyHomeownersHomeowners936Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DEDUCTIBLE; DEPRECIATION; GR-Claim Evaluation; HAIL; ROOF1463INFINITY COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld; Question of Fact; Information Furnished2012-07-02T00:00:002012-08-29T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person1197Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED1464LIBERTY HEALTH CARE NETWORKInjured EmployeeCust Service Claim HandlingNoReferred To; No Jurisdiction; Information Furnished2012-06-29T00:00:002012-09-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&H54531OtherOrganizationINDV1465DRIVER'S INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-07-02T00:00:002012-08-27T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency2038Ins Co - Licensed/ActiveOrganizationINDVTOTAL LOSS; UNDERWRITING CRITERIA1468GEICO INDEMNITY COMPANYInsuredCust Service Claim HandlingYesAdditional Payment Expected; Information Furnished2012-07-02T00:00:002012-10-05T00:00:00Property and CasualtyAutomobileIndividual Private Pass2785Ins Co - Licensed/ActiveOrganizationINDV1470PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYProviderDelays (Claims Handling)NoInformation Furnished; Claim Settled2012-06-27T00:00:002012-07-26T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured1708Ins Co - Licensed/ActiveOrganizationORG1471UNITEDHEALTHCARE OF TEXAS, INC.InsuredDeclination Of VerificationNoInformation Furnished; No Jurisdiction2012-06-29T00:00:002012-08-28T00:00:00Employee Retirement SystemAccident and HealthGroup A&H3363Ins Co - Licensed/ActiveOrganizationINDV1472UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-06-29T00:00:002012-08-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured1348Ins Co - Licensed/ActiveOrganizationORG1473ALLSTATE INSURANCE COMPANYConsumer (Non-Insured)Denial Of ClaimNoCompany Position Upheld; Question of Fact2012-07-02T00:00:002012-09-07T00:00:00Property and CasualtyFire, Allied Lines & CMPBusiness Owners168Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation1476AETNA HEALTH INC.ProviderUnsatisfactory Settle/OfferNoAdditional Payment Expected; Information Furnished2012-06-28T00:00:002012-08-20T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Person; Insured3522Health Maintenance OrgOrganizationORG1477GENERAL INSURANCE COMPANY OF AMERICAThird PartyDelays (Claims Handling)NoRecord Only2012-07-02T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass2508Ins Co - Licensed/ActiveOrganizationINDV1479PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Denial Of Claim; Unsatisfactory Settle/OfferNoAdditional Payment Expected; Information Furnished2012-06-15T00:00:002012-07-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; CHIROPRACTIC; TOTAL LOSS1480USAA CASUALTY INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-06-25T00:00:002012-09-18T00:00:00Property and CasualtyHomeownersHomeowners3607Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; COVERAGE DISPUTE; GR-Claim Evaluation1481HUMANA INSURANCE COMPANYProviderDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue; No Jurisdiction2012-06-29T00:00:002012-08-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured1040Ins Co - Licensed/ActiveOrganizationORG1483TEXAS FARMERS INSURANCE COMPANYInsuredDelays (Claims Handling)YesInformation Furnished; Additional Monies Received2012-06-25T00:00:002012-09-14T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1484STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredCancellationNoCompany Position Upheld; Information Furnished2012-06-25T00:00:002012-08-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE1485UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDelays (Claims Handling)NoNo Jurisdiction2012-06-29T00:00:002012-08-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV1486TEXAS FARM BUREAU CASUALTY INSURANCE COMPANYConsumer (Non-Insured)Cust Service Claim HandlingNoInformation Furnished; Other2012-07-02T00:00:002012-08-24T00:00:00Property and CasualtyMiscellaneousP & C Misc28440Ins Co - Licensed/ActiveOrganizationINDV1488FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredRefund Of PremiumNoInformation Furnished2012-06-29T00:00:002012-08-28T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDV1488NATIONWIDE PROPERTY AND CASUALTY INSURANCE COMPANYInsuredRefund Of PremiumNoInformation Furnished2012-06-29T00:00:002012-08-28T00:00:00Property and CasualtyAutomobileIndividual Private Pass3165Ins Co - Licensed/ActiveOrganizationINDV1489BRISTOL WEST SPECIALTY INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished2012-06-05T00:00:002012-07-11T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Associated Subject Person; Insured8129Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE1490TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredEarnest MoneyNoInformation Furnished2012-07-02T00:00:002012-10-21T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency1444Ins Co - Licensed/ActiveOrganizationINDV1490OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredEarnest MoneyNoInformation Furnished2012-07-02T00:00:002012-10-21T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDV1491OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished2012-06-30T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1823Ins Co - Licensed/ActiveOrganizationINDVREPLACEMENT VEHICLE1492BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONHospitalDelays (Claims Handling)NoInformation Furnished; Claim Not Clean2012-07-02T00:00:002012-08-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationORG1493BOON-CHAPMAN BENEFIT ADMINISTRATORS, INC.ProviderDenial Of ClaimNoNo Jurisdiction2012-05-31T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&H136371Third Party AdministratorsOrganizationINDV1494DAIRYLAND COUNTY MUTUAL INSURANCE COMPANY OF TEXASThird PartyUnsatisfactory Settle/OfferNoCompany Position Upheld; Question of Fact2012-07-02T00:00:002012-08-24T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2737Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation1495HUMANA HEALTH PLAN OF TEXAS, INC.ProviderDenial Of ClaimNoAdditional Monies Received; Information Furnished2012-06-29T00:00:002012-08-10T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured702Health Maintenance OrgOrganizationORGMATERNITY1496STATE FARM LLOYDSInsuredDenial Of Claim; Unsatisfactory Settle/OfferYesInformation Furnished2012-06-29T00:00:002012-10-10T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent3105Ins Co - Licensed/ActiveOrganizationINDV1497ACE AMERICAN INSURANCE COMPANYAttorneyDelays (Claims Handling)NoInformation Furnished; Company Position Upheld2012-07-02T00:00:002012-08-30T00:00:00Property and CasualtyLiabilityGeneral LiabilityAssociated Subject Company; Associated Subject Person; Correspondent Person; Insured Company2327Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1498ACCC INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Claim Settled2012-07-02T00:00:002012-08-30T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured9825Ins Co - Licensed/ActiveOrganizationINDVLOSS OF USE; TOTAL LOSS1500STATE FARM LLOYDSThird PartyDenial Of Claim; Liability DisputeNoInformation Furnished; Company Position Upheld2012-07-05T00:00:002012-08-30T00:00:00Property and CasualtyLiabilityGeneral LiabilityAssociated Subject Company; Associated Subject Person; Insured3105Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1501FIRST AMERICAN TITLE INSURANCE COMPANYConsumer (Non-Insured)Delays (Policyholder Service)NoPolicy Issued/Restored2012-05-31T00:00:002012-08-16T00:00:00Property and CasualtyMiscellaneousTitle Insurance52569Ins Co - Licensed/ActiveOrganizationINDV1502BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONPhysicianDenial Of ClaimNo2012-06-29T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1502Blue Cross Blue Shield of North CarolinaPhysicianNot Within TDI JurisdictionNoNo Jurisdiction2012-06-29T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured66859OtherOrganizationINDVGR-Claim Evaluation1503UNITEDHEALTHCARE INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction2012-06-29T00:00:002012-08-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV1504CIGNA HEALTH AND LIFE INSURANCE COMPANYProviderDenial Of ClaimNo2012-06-20T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person1841Ins Co - Licensed/ActiveOrganizationORG1504CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderNot Within TDI JurisdictionNoNo Jurisdiction2012-06-20T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person2851Ins Co - Licensed/ActiveOrganizationORG1505LOYA INSURANCE COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld; Information Furnished2012-07-06T00:00:002012-08-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured15643Ins Co - Licensed/ActiveOrganizationINDVDRIVER NOT COVERED1507HUMANA INSURANCE COMPANYInsuredDenial Of Claim; Pre-Existing ConditionNoInformation Furnished; Contract Language/Legal Issue2012-07-02T00:00:002013-04-23T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1040Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1508CHRISTIAN FIDELITY LIFE INSURANCE COMPANYOtherAssignment of BenefitsNoClaim Settled2012-07-03T00:00:002012-08-28T00:00:00Life, Accident and HealthLife & AnnuityCredit LifeInsured Company97Ins Co - Licensed/ActiveOrganizationORG1509ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-07-02T00:00:002012-08-31T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Associated Subject Agency936Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE1510UNITED NATIONAL LIFE INSURANCE COMPANY OF AMERICAPhysicianDelays (Claims Handling)YesAdditional Monies Received; Claim Settled2012-07-03T00:00:002012-10-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured871Ins Co - Licensed/ActiveOrganizationINDV1511SAFECO INSURANCE COMPANY OF INDIANAInsuredDelays (Policyholder Service); Refund Of PremiumNoPremium Refunded2012-07-06T00:00:002012-08-29T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company2496Ins Co - Licensed/ActiveOrganizationINDV1512R.V.O.S. FARM MUTUAL INSURANCE COMPANYInsuredCust Service Claim HandlingYesCorrective Action Taken2012-07-06T00:00:002012-10-15T00:00:00Property and CasualtyHomeownersHomeowners2621Ins Co - Licensed/ActiveOrganizationINDV1513AETNA LIFE INSURANCE COMPANYPhysicianDenial Of ClaimNoInformation Furnished2012-07-03T00:00:002012-08-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDV1514SOUTHERN COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Policyholder Service); Refund Of PremiumNoInformation Furnished; Premium Refund2012-07-06T00:00:002012-08-31T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1583Ins Co - Licensed/ActiveOrganizationINDV1515SOUTHERN COUNTY MUTUAL INSURANCE COMPANYInsuredPremium Notice; Refund Of PremiumYesInformation Furnished; Premium Refunded2012-07-02T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass1583Ins Co - Licensed/ActiveOrganizationINDV1517BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-03T00:00:002012-08-14T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life10047Ins Co - Licensed/ActiveOrganizationINDV1518BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDelays (Underwriting)NoNo Jurisdiction2012-07-03T00:00:002012-08-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV1519ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling); Liability DisputeNoCompany Position Upheld; Additional Payment Expected; Information Furnished2012-07-06T00:00:002012-08-31T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured936Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1520R H ADMINISTRATORS, INC.InsuredDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; No Jurisdiction2012-07-03T00:00:002012-08-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&H12370Third Party AdministratorsOrganizationINDV1521UNITEDHEALTHCARE OF TEXAS, INC.ProviderDelays (Claims Handling)No2012-07-03T00:00:002012-08-17T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Person; Insured3363Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation1521UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.ProviderDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; No Jurisdiction2012-07-03T00:00:002012-08-17T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Person; Insured14666Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation1522UNITEDHEALTHCARE OF TEXAS, INC.InsuredDelays (Policyholder Service); OtherNoInformation Furnished2012-07-02T00:00:002012-09-14T00:00:00Medicare HMOAccident and HealthIndividual A & HAssociated Subject Person3363Ins Co - Licensed/ActiveOrganizationINDVPRESCRIPTION1522ROGERS, MICHAEL EARLEInsuredUnauthorized ActsNoQuestion of Fact2012-07-02T00:00:002012-09-14T00:00:00Medicare HMOAccident and HealthIndividual A & HAssociated Subject Person910315AgentIndividualINDVPRESCRIPTION1524AMERICAN RISK INSURANCE COMPANY, INC.InsuredUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-07-03T00:00:002012-10-02T00:00:00Property and CasualtyHomeownersHomeowners27377Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; HAIL1525OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDelays (Claims Handling)NoAdditional Payment Expected; Information Furnished2012-07-06T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private PassAlias Name1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; TOTAL LOSS1526AETNA HEALTH AND LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-03T00:00:002012-08-13T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured195Ins Co - Licensed/ActiveOrganizationORG1527UNITEDHEALTHCARE INSURANCE COMPANYInsuredDenial Of ClaimYesFailure to Timely Respond2012-07-03T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV1528BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredRefusal to InsureNoNo Jurisdiction2012-07-03T00:00:002012-07-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV1529LIFE INSURANCE COMPANY OF NORTH AMERICAInsuredDenial Of ClaimNoAdditional Monies Received; Information Furnished2012-06-29T00:00:002012-08-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2157Ins Co - Licensed/ActiveOrganizationINDV1531UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.OtherDelays (Claims Handling)NoNo Jurisdiction; Information Furnished2012-07-03T00:00:002012-08-27T00:00:00Medicare Managed Care for HMOAccident and HealthGroup A&H14666Health Maintenance OrgOrganizationORG1532OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDenial Of ClaimNoClaim Settled; Information Furnished2012-07-06T00:00:002012-08-31T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DIMINISHED VALUE; LOSS OF USE; UNCOOPERATIVE INSURED1533UNITEDHEALTHCARE INSURANCE COMPANYInsuredDenial Of Pymt For Emerg Care; PPACA-Out-Of-Ntwk Emerg Care; Unsatisfactory Settle/OfferYesAdditional Monies Received; Stat Pen Pd-46 To 90 Dys Late; Clean Claims Violation2012-07-03T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDVEMERGENCY CARE; GR-Claim Evaluation1534HUMANA INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction; Additional Monies Received2012-07-03T00:00:002012-09-04T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1040Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN1535CAPITOL COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue2012-06-25T00:00:002012-08-01T00:00:00Property and CasualtyHomeownersRental2992Ins Co - Licensed/ActiveOrganizationINDV1537PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-07-06T00:00:002012-10-01T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVACV; ADJUSTER'S HANDLING; GR-Claim Evaluation; TOTAL LOSS1539CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoRecord Only2012-07-03T00:00:002012-08-29T00:00:00Employee Retirement SystemAccident and HealthGroup A&HAssociated Subject Company; Correspondent Person; Insured2851Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation1540MGA INSURANCE COMPANY, INC.AttorneyCust Service Claim HandlingNoCompany Position Upheld; Information Furnished2012-06-25T00:00:002012-08-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Associated Subject Company; Insured812Ins Co - Licensed/ActiveOrganizationORG1541LINCOLN NATIONAL LIFE INSURANCE COMPANY, THERelativeOtherNoInformation Furnished2012-07-03T00:00:002012-08-24T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2172Ins Co - Licensed/ActiveOrganizationINDV1542ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-07-06T00:00:002012-08-31T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured936Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1544BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-07-03T00:00:002012-08-30T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company; Associated Subject Person; Insured10047Ins Co - Licensed/ActiveOrganizationINDV1545PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished; Claim Settled2012-07-06T00:00:002012-08-31T00:00:00Property and CasualtyAutomobileIndividual Private PassCorrespondent Person; Insured1708Ins Co - Licensed/ActiveOrganizationINDVCHIROPRACTIC; GR-Claim Evaluation1546PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld; Information Furnished2012-06-25T00:00:002012-08-31T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1708Ins Co - Licensed/ActiveOrganizationORGREPLACEMENT VEHICLE; TOTAL LOSS1547OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDenial Of ClaimNoContract Language/Legal Issue; Company Position Upheld2012-07-06T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDV1550ACCC INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld; Contract Language/Legal Issue; Information Furnished2012-06-25T00:00:002012-08-31T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person9825Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; DRIVER NOT COVERED; GR-Claim Evaluation; NAMED DRIVER POLICY; POLICY EXCLUSION; UNDERWRITING CRITERIA1551UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoRecord Only2012-06-06T00:00:002013-05-02T00:00:00Life, Accident and HealthMiscellaneousNo Line SpecifiedInsured1348Ins Co - Licensed/ActiveOrganizationINDV1554LOYA INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished2012-07-06T00:00:002012-08-29T00:00:00Property and CasualtyAutomobileIndividual Private Pass15643Ins Co - Licensed/ActiveOrganizationINDV1555BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-02T00:00:002012-08-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG1556GLOBE LIFE AND ACCIDENT INSURANCE COMPANYRelativeCancellation; Cash Value; MisrepresentationNoInformation Furnished; Additional Payment Expected2012-06-28T00:00:002012-08-22T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured917Ins Co - Licensed/ActiveOrganizationINDVRESCISSION1557UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoAdditional Monies Received2012-06-07T00:00:002012-08-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV1558BATTARBEE, LARRY VERNONInsuredAgent Handling; XX-Failure to Submit AppYesReferred for Disciplinary Actn; Failure to Timely Respond2012-05-23T00:00:002012-10-31T00:00:00Property and CasualtyFire, Allied Lines & CMPBusiness Owners529266AgentIndividualINDV1560AAA TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished2012-07-06T00:00:002012-08-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass2286Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE1561BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderPrompt Pay; Unsatisfactory Settle/OfferNoInformation Furnished; Claim Not Clean2012-07-03T00:00:002013-02-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG1562SOUTHERN COUNTY MUTUAL INSURANCE COMPANYConsumer (Non-Insured)Cust Service Claim Handling; Delays (Claims Handling)YesClaim Settled2012-07-06T00:00:002012-08-29T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1583Ins Co - Licensed/ActiveOrganizationINDV1563ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyCust Service Claim Handling; Unsatisfactory Settle/OfferNoInformation Furnished2012-07-06T00:00:002012-09-04T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE1564BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONOtherPrompt PayNoInformation Furnished; Claim Not Clean2012-07-03T00:00:002012-09-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG1565GRIFFIN GENERAL AGENCY INCAgentCommissionsNoNo Jurisdiction2012-07-06T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass4712Ins Co - Licensed/ActiveOrganizationINDV1568AMERICAN INCOME LIFE INSURANCE COMPANYInsuredCancellation; Dependent CoverageNoPolicy Issued/Restored2012-07-03T00:00:002012-12-12T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Person109Ins Co - Licensed/ActiveOrganizationINDV1569BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoRecord Only2012-07-03T00:00:002013-03-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Self-Funded / ErisaOrganizationINDV1570BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderPrompt PayNoInformation Furnished; Claim Not Clean2012-07-03T00:00:002013-02-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG1571BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderSB418 Rule ViolationNoClaim Settled2012-07-03T00:00:002012-09-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG1572OHIO NATIONAL LIFE ASSURANCE CORPORATIONInsuredRefund Of PremiumNoContract Language/Legal Issue; Information Furnished2012-07-03T00:00:002012-08-22T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities1072Ins Co - Licensed/ActiveOrganizationINDV1573AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-03T00:00:002012-08-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationORG1575CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction; Information Furnished2012-07-03T00:00:002012-08-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORG1576FIRST HEALTH/TRAVELERS HCNProviderURA Failed To Prov Pr-To-Pr Rv; URA Telephone AccessNoInformation Furnished2012-06-29T00:00:002013-05-29T00:00:00Utilization Review AgentMiscellaneousWorkers' Compensation NtwkInsured54191WC Healthcare Provider NtwkOrganizationORG1577CONNECTICUT GENERAL LIFE INSURANCE COMPANYPhysicianUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-05T00:00:002012-08-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Ins Co - Licensed/ActiveOrganizationINDV1578HUMANA INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoClaim Settled; Information Furnished; Contract Language/Legal Issue2012-07-05T00:00:002012-08-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationINDV1579AAA TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredRefund Of Premium; Refusal to InsureYesAdditional Monies Received2012-06-09T00:00:002012-07-27T00:00:00Life, Accident and HealthAutomobileIndividual Private Pass2286Ins Co - Licensed/ActiveOrganizationINDV1579VAHDAT, NILOUFARInsuredAgent HandlingYesInformation Furnished2012-06-09T00:00:002012-07-27T00:00:00Life, Accident and HealthAutomobileIndividual Private Pass1075756AgentIndividualINDV1582CENTRAL STATES INDEMNITY CO. OF OMAHAConsumer (Non-Insured)Pre-Existing ConditionNoInformation Furnished; Contract Language/Legal Issue2012-07-02T00:00:002012-09-18T00:00:00Property and CasualtyMiscellaneousP & C MiscCorrespondent Person; Insured3300Ins Co - Licensed/ActiveOrganizationINDVPOLICY EXCLUSION1585LANDMARK LIFE INSURANCE COMPANYOtherOtherNoInformation Furnished2012-07-05T00:00:002012-09-17T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2191Ins Co - Licensed/ActiveOrganizationORG1586Allied Home WarrantyInsuredDelays (Claims Handling)NoRecord Only2012-07-06T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company66886OtherOrganizationINDV1587GILBERT, JEFFERY WAYNEInsuredPremium and RatingYesInformation Furnished2012-07-06T00:00:002012-10-12T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company889758AgentIndividualINDV1588OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYLienholderDelays (Claims Handling)NoInformation Furnished2012-05-23T00:00:002012-12-05T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationORG1589INDEPENDENT ORDER OF FORESTERS, THEBeneficiaryCust Service Claim Handling; Delays (Claims Handling)NoInformation Furnished; Additional Monies Received2012-07-02T00:00:002012-10-01T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured13242Ins Co - Licensed/ActiveOrganizationINDV1590ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredDelays (Policyholder Service); Denial Of ClaimNoQuestion of Fact; Information Furnished2012-07-06T00:00:002012-08-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDV1591LOYA INSURANCE COMPANYProviderAssignment of Benefits; Delays (Claims Handling)NoAdditional Monies Received; Information Furnished; Claim Settled2012-07-02T00:00:002012-11-26T00:00:00Property and CasualtyAutomobileIndividual Private PassCorrespondent Person; Insured15643Ins Co - Licensed/ActiveOrganizationORG1592ALLSTATE TEXAS LLOYD'SInsuredDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-07-06T00:00:002012-08-28T00:00:00Property and CasualtyHomeownersHomeowners3721Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; FOUNDATION 1592FEGALE, ELMER GABRIELInsuredDenial Of ClaimNo2012-07-06T00:00:002012-08-28T00:00:00Property and CasualtyHomeownersHomeowners605613AgentIndividualINDVCOVERAGE DISPUTE; FOUNDATION 1593BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/Offer; Usual And CustomaryNoNo Jurisdiction2012-07-02T00:00:002012-08-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG1594BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoCompany Position Upheld2012-07-02T00:00:002012-09-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGBUNDLING; GR-Claim Evaluation1595GENERAL INSURANCE COMPANY OF AMERICAThird PartyDelays (Claims Handling)NoInformation Furnished2012-07-06T00:00:002012-09-05T00:00:00Property and CasualtyAutomobileIndividual Private Pass2508Ins Co - Licensed/ActiveOrganizationINDVDIMINISHED VALUE1596BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction2012-07-02T00:00:002012-08-08T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG1597VIZCAYA, SANDRAInsurance CompanyAgency Balance; Unauthorized ActsYesReferred To2012-07-02T00:00:002012-09-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&H835631AgentIndividualORG1598FOREMOST LLOYDS OF TEXASConsumer (Non-Insured)Unsatisfactory Settle/OfferNoInformation Furnished2012-07-06T00:00:002012-09-04T00:00:00Property and CasualtyHomeownersHomeownersInsured698Ins Co - Licensed/ActiveOrganizationORGDAMAGE DISPUTE; OVERHEAD AND PROFIT1600BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction2012-07-02T00:00:002012-08-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG1601CONNECTICUT GENERAL LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction2012-07-02T00:00:002012-08-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationINDV1602HUMANA INSURANCE COMPANYPhysicianClaim Recoding/Bundling; Unsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-07-02T00:00:002012-08-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationINDVBUNDLING1603HOCHHEIM PRAIRIE CASUALTY INSURANCE COMPANYConsumer (Non-Insured)Refund Of PremiumNoCompany Position Upheld2012-07-06T00:00:002012-10-09T00:00:00Property and CasualtyHomeownersHomeowners1152Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE1604ARCH INSURANCE COMPANYAttorneyDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Payment Expected; Information Furnished2012-07-06T00:00:002012-08-30T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied LinesAssociated Subject Person; Third Party Admin-Licensed625Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING1605BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/Offer; Usual And CustomaryNoAdditional Monies Received2012-07-02T00:00:002012-08-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG1606BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/Offer; Usual And CustomaryNoInformation Furnished2012-07-02T00:00:002012-08-22T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation1607LIFE INSURANCE COMPANY OF NORTH AMERICAInsuredDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-07-02T00:00:002012-09-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2157Ins Co - Licensed/ActiveOrganizationINDV1608UNITEDHEALTHCARE INSURANCE COMPANYInsuredOverchargesNoContract Language/Legal Issue; Information Furnished2012-07-02T00:00:002013-05-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDVPRESCRIPTION1609TEXAS FARMERS INSURANCE COMPANYOtherUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-07-06T00:00:002012-08-22T00:00:00Property and CasualtyHomeownersHomeownersInsured1452Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; HAIL; OVERHEAD AND PROFIT; ROOF1610UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-02T00:00:002012-08-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG1611WESTERN HERITAGE INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling); Denial Of ClaimYesContract Language/Legal Issue; Information Furnished2012-07-06T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured51924Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF; GR-Claim Evaluation1612RATTIKIN TITLE COMPANYInsuredUnrecorded DocumentsNoCompany Position Upheld2012-07-06T00:00:002012-08-24T00:00:00Property and CasualtyMiscellaneousTitle InsuranceAssociated Subject Company66899AgentOrganizationINDV1613HUMANADENTAL INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoAdditional Monies Received; Information Furnished2012-07-02T00:00:002012-08-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1182Ins Co - Licensed/ActiveOrganizationORG1614HUMANA HEALTH PLAN OF TEXAS, INC.RelativeDelays In Authorization; XX-Coverage QuestionNoNo Jurisdiction2012-06-29T00:00:002012-08-29T00:00:00Medicare HMOAccident and HealthIndividual A & H702Health Maintenance OrgOrganizationINDVSENIOR CITIZEN1616OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-07-06T00:00:002012-09-20T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; BURDEN OF PROOF; DAMAGE DISPUTE1617AMICA MUTUAL INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished2012-07-06T00:00:002012-08-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass3532Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA1618BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling); Usual And CustomaryNoNo Jurisdiction2012-07-02T00:00:002012-11-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Self-Funded / ErisaOrganizationORG1620ACCC INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)YesInformation Furnished; Additional Monies Received; Additional Payment Expected2012-07-06T00:00:002012-08-31T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Associated Subject Agency; Insured9825Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF; DAMAGE DISPUTE; GR-Claim Evaluation; LOSS OF USE; SUPPLEMENTARY PAYMENT; UNCOOPERATIVE INSURED; UNDERWRITING CRITERIA1621SAFECO INSURANCE COMPANY OF INDIANAConsumer (Non-Insured)Unsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-07-06T00:00:002012-09-04T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person2496Ins Co - Licensed/ActiveOrganizationORGDAMAGE DISPUTE; OVERHEAD AND PROFIT1622CHARTIS CASUALTY COMPANYThird PartyDenial Of ClaimNoContract Language/Legal Issue2012-07-06T00:00:002012-09-20T00:00:00Property and CasualtyHomeownersHomeownersInsured Company3464Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF; GR-Claim Evaluation; SUBROGATION; UNDERWRITING CRITERIA1622ASI LLOYDSThird PartyDelays (Claims Handling)YesCorrective Action Taken2012-07-06T00:00:002012-09-20T00:00:00Property and CasualtyHomeownersHomeownersInsured Company14728Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF; GR-Claim Evaluation; SUBROGATION; UNDERWRITING CRITERIA1623CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling); Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-02T00:00:002012-08-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Ins Co - Licensed/ActiveOrganizationORG1624FOREMOST LLOYDS OF TEXASRelativeCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-07-06T00:00:002012-08-27T00:00:00Property and CasualtyHomeownersHomeownersInsured698Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; DAMAGE DISPUTE; HAIL; ROOF; WATER DAMAGE1625ALLSTATE INDEMNITY COMPANYInsuredDelays (Policyholder Service); Premium and RatingYesPremium Refunded; Additional Monies Received; Information Furnished2012-07-06T00:00:002012-08-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Associated Subject Person167Ins Co - Licensed/ActiveOrganizationINDVMULTIPLE INSUREDS; UNDERWRITING CRITERIA1626BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONRelativeAccess to Care; Denial Of ClaimNo2012-07-02T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1626Blue Cross and Blue Shield of South CarolinaRelativeNot Within TDI JurisdictionNoNo Jurisdiction2012-07-02T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured67961OtherOrganizationINDVGR-Claim Evaluation1627OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYAttorneyDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-07-06T00:00:002012-08-31T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Associated Subject Person; Insured1823Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; BURDEN OF PROOF; COVERAGE DISPUTE; GR-Claim Evaluation; NAMED DRIVER POLICY; UNCOOPERATIVE INSURED; UNDERWRITING CRITERIA1629UNIVERSAL NORTH AMERICA INSURANCE COMPANYRelativeCust Service Claim Handling; Denial Of Claim; Liability DisputeNoInformation Furnished; Contract Language/Legal Issue2012-07-06T00:00:002012-09-05T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person23526Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; AFTERMARKET PARTS; BURDEN OF PROOF; GR-Claim Evaluation1634AMERICAN GENERAL LIFE INSURANCE COMPANYInsuredRefusal to InsureNoPolicy Not In Force; Information Furnished2012-07-06T00:00:002012-09-21T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life152Ins Co - Licensed/ActiveOrganizationINDV1636BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderAccess to Care; Lifetime/Annual Limits; Medical NecessityNoNo Jurisdiction2012-07-06T00:00:002012-08-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationORGDEDUCTIBLE1639METROPOLITAN LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-06T00:00:002012-09-20T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H13191Ins Co - Licensed/ActiveOrganizationINDV1640DRIVER'S INSURANCE COMPANYInsuredDisaster; Unsatisfactory Settle/OfferNoInformation Furnished; Additional Payment Expected2012-05-14T00:00:002012-08-17T00:00:00Life, Accident and HealthAutomobileIndividual Private PassGR Elected Official2038Ins Co - Licensed/ActiveOrganizationINDV2012 NORTH TEXAS TORNADOES; ACV; GR-Claim Evaluation; TOTAL LOSS1642UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoInsufficient Information2012-07-06T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1348Ins Co - Licensed/ActiveOrganizationORG1643BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredOtherNoCorrective Action Taken; Information Furnished2012-07-06T00:00:002012-08-22T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationINDV1646TEXAS SERVICE LIFE INSURANCE COMPANYInsuredCancellationYesInformation Furnished; Cancellation Withdrawn; Additional Payment Expected2012-07-06T00:00:002012-08-27T00:00:00Life, Accident and HealthLife & AnnuityCredit LifeAssociated Subject Person; Insured3325Ins Co - Licensed/ActiveOrganizationINDV1647UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling); Denial Of ClaimNoNo Jurisdiction2012-07-06T00:00:002012-08-07T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1348Ins Co - Licensed/ActiveOrganizationORGBUNDLING; SENIOR CITIZEN1648The Loomis CompanyProviderDenial Of ClaimNoNo Jurisdiction2012-07-06T00:00:002012-09-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured66920Third Party AdministratorsOrganizationORG1649TEXAS SERVICE LIFE INSURANCE COMPANYInsuredRefund Of Premium; XX-Payment Not CreditedYesInformation Furnished; Additional Payment Expected2012-07-06T00:00:002012-08-28T00:00:00Life, Accident and HealthLife & AnnuityPre-Paid Funeral PlanAssociated Subject Person3325Ins Co - Licensed/ActiveOrganizationINDV1651SENIOR LIFE INSURANCE COMPANYConsumer (Non-Insured)MisrepresentationNoInformation Furnished2012-07-06T00:00:002012-08-29T00:00:00Life, Accident and HealthLife & AnnuityPre-Paid Funeral Plan16102Ins Co - Licensed/ActiveOrganizationINDV1652UNITEDHEALTHCARE OF TEXAS, INC.InsuredDelays In AuthorizationYesInformation Furnished2012-07-06T00:00:002012-08-30T00:00:00Health Maintenance OrgAccident and HealthGroup A&H3363Health Maintenance OrgOrganizationINDV1653SAFECO INSURANCE COMPANY OF INDIANAInsuredCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferYesCompany Position Upheld; Additional Monies Received; Additional Payment Expected2012-07-09T00:00:002013-04-05T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person2496Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; DAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF; UNDERWRITING CRITERIA1654TEXAS SERVICE LIFE INSURANCE COMPANYInsuredPremium NoticeNoComplainant Retained Attorney; Information Furnished; Policy Not In Force2012-07-06T00:00:002012-11-06T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured3325Ins Co - Licensed/ActiveOrganizationINDV1655RESPONSE WORLDWIDE DIRECT AUTO INSURANCE COMPANYThird PartyDenial Of ClaimYesAdditional Monies Received2012-07-09T00:00:002012-10-02T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent629Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation1656BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction2012-07-06T00:00:002012-08-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured10047Ins Co - Licensed/ActiveOrganizationORG1657NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA.Third PartyDelays (Claims Handling)NoAdditional Payment Expected; Information Furnished; Corrective Action Taken2012-07-09T00:00:002012-09-10T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company1931Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1658TEXAS FARMERS INSURANCE COMPANYInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferNoClaim Settled; Additional Monies Received; Information Furnished2012-07-09T00:00:002012-09-04T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person1452Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; DAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF1659METROPOLITAN LIFE INSURANCE COMPANYProviderOtherNoInformation Furnished; Contract Language/Legal Issue2012-07-06T00:00:002012-08-31T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company13191Ins Co - Licensed/ActiveOrganizationORG1661UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-06T00:00:002012-08-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG1662COMPANION PROPERTY AND CASUALTY INSURANCE COMPANYRelativeCancellation; Denial Of Claim; Use of Credit ReportsNoClaim Settled2012-07-09T00:00:002013-07-29T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company; Insured10484Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; CREDIT REPORT; GR-Claim Evaluation; MOLD; ROOF; UNDERWRITING CRITERIA; WATER DAMAGE1663CIGNA HEALTH AND LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-12T00:00:002012-09-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1841Ins Co - Licensed/ActiveOrganizationORG1664UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-09T00:00:002012-08-08T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationORG1665UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-09T00:00:002012-08-29T00:00:00Medicare HMOAccident and HealthIndividual A & HAssociated Subject Company; Insured1348Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN1667OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoCompany Position Upheld2012-07-09T00:00:002012-09-05T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; LOSS OF USE; TOTAL LOSS1667WILSON, MIMI ELIZABETHThird PartyCust Service Claim Handling; Delays (Claims Handling)NoInformation Furnished2012-07-09T00:00:002012-09-05T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Insured172393Claims AdjusterIndividualINDVADJUSTER'S HANDLING; LOSS OF USE; TOTAL LOSS1668GRAMERCY INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferNoClaim Settled; Information Furnished2012-07-09T00:00:002012-09-05T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company1062Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; UNCOOPERATIVE INSURED1669HUMANA INSURANCE COMPANYProviderPrompt Pay; Recoupment Of Claims PaymentNoAdditional Monies Received; No Jurisdiction2012-07-06T00:00:002012-09-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORG1670DELEON, JULIEInsuredUnauthorized ActsYesInformation Furnished2012-07-09T00:00:002012-10-04T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company138595AgentIndividualINDV1671Bandera Title CompanyConsumer (Non-Insured)OtherNoQuestion of Fact2012-07-09T00:00:002012-09-11T00:00:00Property and CasualtyMiscellaneousTitle Insurance66932AgentOrganizationORG1673SAFECO INSURANCE COMPANY OF INDIANAInsuredNon-RenewalNoCorrective Action Taken; Information Furnished2012-07-09T00:00:002012-09-18T00:00:00Property and CasualtyHomeownersHomeowners2496Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA1674HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredCust Service Claim HandlingYesInformation Furnished; Claim Settled2012-07-09T00:00:002012-09-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person2362Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1675STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredPremium and RatingNoCompany Position Upheld; Information Furnished2012-07-09T00:00:002012-09-04T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent1510Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA1676AETNA LIFE INSURANCE COMPANYPhysicianDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-07-05T00:00:002012-08-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV1677KANAWHA INSURANCE COMPANYInsuredDelays (Policyholder Service)YesCorrective Action Taken; Information Furnished; Additional Payment Expected2012-07-06T00:00:002012-08-31T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured3637Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN1679WELLINGTON INSURANCE COMPANYInsuredDenial Of Claim; Premium and RatingNoInformation Furnished; Company Position Upheld2012-07-09T00:00:002012-09-05T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company18251Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF; LOSS OF USE; UNDERWRITING CRITERIA; WATER DAMAGE1680HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.InsuredDelays (Claims Handling)NoNo Jurisdiction; Information Furnished2012-07-09T00:00:002012-11-27T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HThird Party Admin-Licensed27417Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN1681PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredEndorsement / Rider; Refusal to InsureNoInformation Furnished; Non-Renewal Rescinded2012-07-09T00:00:002012-09-05T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA1682CONNECTICUT GENERAL LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction2012-07-06T00:00:002012-08-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Ins Co - Licensed/ActiveOrganizationINDV1683STATE FARM LLOYDSInsuredDenial Of Claim; Unsatisfactory Settle/OfferNoQuestion of Fact; Corrective Action Taken2012-07-09T00:00:002012-09-04T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent3105Ins Co - Licensed/ActiveOrganizationINDV2012 NORTH TEXAS TORNADOES; ADJUSTER'S HANDLING; APPRAISAL; DAMAGE DISPUTE; ROOF1683MILKOVISCH, RANDY EUGENEInsuredCust Service Claim HandlingNoInformation Furnished2012-07-09T00:00:002012-09-04T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent639172Claims AdjusterIndividualINDV2012 NORTH TEXAS TORNADOES; ADJUSTER'S HANDLING; APPRAISAL; DAMAGE DISPUTE; ROOF1685Alliance Insurance & AssociatesThird PartyCust Service Claim Handling; Deficient Claim Notice; Delays (Claims Handling)YesInformation Furnished; Corrective Action Taken2012-07-09T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured Company66942Insurance AgencyOrganizationINDVBURDEN OF PROOF; GR-Claim Evaluation; UNCOOPERATIVE INSURED1686STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoQuestion of Fact; Additional Monies Received2012-07-05T00:00:002012-12-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation1687LIBERTY LIFE ASSURANCE COMPANY OF BOSTONInsuredDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-07-06T00:00:002012-08-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2205Ins Co - Licensed/ActiveOrganizationINDV1689PROGRESSIVE CASUALTY INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Appraisal Process Invoked2012-07-09T00:00:002012-08-31T00:00:00Property and CasualtyMiscellaneousWatercraft1763Ins Co - Licensed/ActiveOrganizationINDVAPPRAISAL; BURDEN OF PROOF; DAMAGE DISPUTE; POLICY EXCLUSION; UNDERWRITING CRITERIA1690UNITED NATIONAL INSURANCE COMPANYInsuredPremium and RatingYesInformation Furnished2012-07-09T00:00:002012-10-23T00:00:00Property and CasualtyLiabilityXX-General55959Ins Co - Surplus LinesOrganizationORG1691BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-07-09T00:00:002012-09-26T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Person; Insured10047Ins Co - Licensed/ActiveOrganizationINDV1692HOCHHEIM PRAIRIE FARM MUTUAL INSURANCE ASSOCIATIONInsuredNon-RenewalNoInformation Furnished2012-07-09T00:00:002012-08-24T00:00:00Property and CasualtyHomeownersHomeowners2350Ins Co - Licensed/ActiveOrganizationINDV1693LOYAL AMERICAN LIFE INSURANCE COMPANYInsuredDelays (Policyholder Service); Refund Of PremiumNoPremium Refunded2012-07-09T00:00:002012-10-26T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2129Ins Co - Licensed/ActiveOrganizationINDV1694BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-07-02T00:00:002012-08-30T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationINDV1695DAIRYLAND COUNTY MUTUAL INSURANCE COMPANY OF TEXASInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Question of Fact; Company Position Upheld2012-07-09T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileMotorcycle2737Ins Co - Licensed/ActiveOrganizationINDVACV; GR-Claim Evaluation; TOTAL LOSS1696BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of Claim; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-09T00:00:002012-08-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG1697DELTA DENTAL OF CALIFORNIARelativeXX-Coverage QuestionYesClaim Settled2012-06-28T00:00:002012-09-24T00:00:00Children Health Insurance PlanAccident and HealthGroup A&HAssociated Subject Person; Insured44231Health Maintenance OrgOrganizationINDV1698STATE FARM LLOYDSInsuredNot Within TDI JurisdictionNoReferred To; No Jurisdiction2012-07-09T00:00:002012-08-30T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company3105Ins Co - Licensed/ActiveOrganizationINDV1699AETNA LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction2012-07-02T00:00:002012-10-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Self-Funded / ErisaOrganizationINDV1699BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredOtherNo2012-07-02T00:00:002012-10-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV1700STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYAgentCust Service Claim Handling; Delays (Claims Handling)NoInformation Furnished; Question of Fact2012-07-09T00:00:002012-10-04T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV1701TEXAS FARMERS INSURANCE COMPANYInsuredDelays (Claims Handling)NoCompany Position Upheld2012-07-09T00:00:002012-09-10T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; HAIL; ROOF; WATER DAMAGE1701MACKEY, CHRISTOPHER LANCEInsuredCust Service Claim HandlingNoInformation Furnished2012-07-09T00:00:002012-09-10T00:00:00Property and CasualtyHomeownersHomeowners671357Claims AdjusterIndividualINDVADJUSTER'S HANDLING; GR-Claim Evaluation; HAIL; ROOF; WATER DAMAGE1702HUMANA INSURANCE COMPANYProviderDelays (Claims Handling)NoAdditional Monies Received; No Jurisdiction2012-07-05T00:00:002012-08-30T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1040Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN1703OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received; Claim Settled2012-07-09T00:00:002012-09-18T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; LOSS OF USE; SUPPLEMENTARY PAYMENT1703G&M ENTERPRISES INCThird PartyCust Service Claim HandlingNoInformation Furnished2012-07-09T00:00:002012-09-18T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company24970Insurance AgencyOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; LOSS OF USE; SUPPLEMENTARY PAYMENT1704RELIABLE LIFE INSURANCE COMPANY, THERelativeOtherNoInformation Furnished2012-07-02T00:00:002012-08-31T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person1704Ins Co - Licensed/ActiveOrganizationINDV1704MONUMENTAL LIFE INSURANCE COMPANYRelativeOtherNoInformation Furnished2012-07-02T00:00:002012-08-31T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person2010Ins Co - Licensed/ActiveOrganizationINDV1705RESERVE NATIONAL INSURANCE COMPANYInsuredDenial Of ClaimNoAdditional Payment Expected; Contract Language/Legal Issue; Information Furnished2012-07-09T00:00:002012-08-30T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1659Ins Co - Licensed/ActiveOrganizationINDV1706UNITEDHEALTHCARE OF TEXAS, INC.ProviderDelays (Claims Handling); Denial Of ClaimNoNo Jurisdiction; Information Furnished2012-07-02T00:00:002012-09-07T00:00:00Medicare HMOAccident and HealthGroup A&HAssociated Subject Company; Correspondent Person; Insured; Third Party Admin-Licensed3363Health Maintenance OrgOrganizationORGSENIOR CITIZEN1707HOME STATE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-07-06T00:00:002012-09-10T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Third Party Admin-Licensed2362Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1708KEETCH, KEVIN GRANTInsuredDelays (Underwriting)NoPremium Refunded; Information Furnished2012-07-02T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileBusiness AutomobileAssociated Subject Company142169AgentIndividualINDV1709UNITEDHEALTHCARE OF TEXAS, INC.ProviderDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-07-02T00:00:002012-09-05T00:00:00Medicare HMOAccident and HealthGroup A&HCorrespondent Person3363Health Maintenance OrgOrganizationORGSENIOR CITIZEN1710UNITEDHEALTHCARE OF TEXAS, INC.ProviderDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-07-12T00:00:002012-09-04T00:00:00Health Maintenance OrgAccident and HealthGroup A&HAssociated Subject Company; Insured; Third Party Admin-Licensed3363Health Maintenance OrgOrganizationORGSENIOR CITIZEN1711AETNA LIFE INSURANCE COMPANYProviderDenial Of Claim; Medical NecessityNoQuestion of Fact2012-07-06T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; MULTIPLE INSUREDS1712HERTZ CLAIM MANAGEMENTThird PartyCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received; Claim Settled2012-07-09T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass13349Claimant RepresentativeOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation1713ESURANCE INSURANCE COMPANYProviderCust Service Claim Handling; Unsatisfactory Settle/OfferNoAdditional Monies Received; Claim Settled; Information Furnished2012-07-09T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1350Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING1714GARDEN STATE LIFE INSURANCE COMPANYRelativePremium NoticeYesInformation Furnished2012-07-02T00:00:002012-09-04T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities2497Ins Co - Licensed/ActiveOrganizationINDV1715AMERICAN HOME SHIELDInsuredRefund Of PremiumNoRecord Only2012-07-03T00:00:002012-07-27T00:00:00Property and CasualtyHomeownersHomeowners66787OtherOrganizationINDV1717CONSUMERS COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; Claim Settled2012-07-03T00:00:002012-08-31T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company2806Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; LOSS OF USE1718BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-03T00:00:002012-08-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationORG1719DELTA DENTAL INSURANCE COMPANYPhysicianDelays (Claims Handling)NoNo Jurisdiction2012-07-06T00:00:002012-09-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured2752Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1720AMERICAN RISK INSURANCE COMPANY, INC.InsuredUnsatisfactory Settle/OfferNoCompany Position Upheld; Question of Fact2012-07-09T00:00:002012-09-11T00:00:00Property and CasualtyHomeownersHomeowners27377Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF1723LIBERTY COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferYesInsufficient Information; Additional Monies Received2012-07-09T00:00:002012-09-17T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured3762Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DEPRECIATION; GR-Claim Evaluation1724UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoAdditional Monies Received2012-07-05T00:00:002012-08-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationORG1725FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)NoInformation Furnished; Additional Monies Received2012-07-05T00:00:002012-09-10T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured2623Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; SUPPLEMENTARY PAYMENT1727AVIVA LIFE AND ANNUITY COMPANYInsuredRefund Of PremiumYesAdditional Payment Expected; Information Furnished2012-07-05T00:00:002012-10-23T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2959Ins Co - Licensed/ActiveOrganizationINDV1728HUMANADENTAL INSURANCE COMPANYInsuredBalance Billing; Unsatisfactory Settle/OfferNoContract Language/Legal Issue2012-07-06T00:00:002012-08-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1182Ins Co - Licensed/ActiveOrganizationINDV1729STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDenial Of ClaimNoQuestion of Fact; Company Position Upheld2012-07-06T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation1730HUMANA INSURANCE COMPANYInsuredPremium and RatingNoContract Language/Legal Issue; Information Furnished2012-07-09T00:00:002012-09-26T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1040Ins Co - Licensed/ActiveOrganizationINDVFEDERAL HEALTH CARE REFORM1731UNITED SERVICES AUTOMOBILE ASSOCIATIONInsuredPremium and RatingNoInformation Furnished2012-07-02T00:00:002012-09-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass1254Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN1732CONNECTICUT GENERAL LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished2012-07-05T00:00:002012-08-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Ins Co - Licensed/ActiveOrganizationINDV1733Value OptionsProviderDenial Of ClaimNoOther2012-07-05T00:00:002012-10-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured66973OtherOrganizationINDV1734STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Payment Expected; Contract Language/Legal Issue2012-07-05T00:00:002012-08-30T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED1735COMPLIANCE DEPOTConsumer (Non-Insured)OtherYesReferred To2012-07-09T00:00:002012-09-19T00:00:00Property and CasualtyMiscellaneousNo Line Specified66446OtherOrganizationINDV1736AETNA HEALTH AND LIFE INSURANCE COMPANYProviderDenial Of ClaimNo2012-07-05T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured195Ins Co - Licensed/ActiveOrganizationINDV1736AETNA LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-05T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDV1737ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Question of Fact2012-07-05T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured936Ins Co - Licensed/ActiveOrganizationINDV1738SENIOR INSURANCE BROKERS, LLCConsumer (Non-Insured)MisrepresentationNoQuestion of Fact2012-07-05T00:00:002012-11-20T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Agent43870Insurance AgencyOrganizationINDV1738LONEY, CORIEConsumer (Non-Insured)MisrepresentationNo2012-07-05T00:00:002012-11-20T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Agent1099267AgentIndividualINDV1739Texas Security General Insurance AgencyInsuredRefund Of PremiumNoCompany Position Upheld2012-07-05T00:00:002012-09-25T00:00:00Property and CasualtyHomeownersMobile Homeowner73703Insurance AgencyOrganizationINDV1739C.K. Premium Finance LLCInsuredRefund Of PremiumNoCompany Position Upheld; Premium Refunded2012-07-05T00:00:002012-09-25T00:00:00Property and CasualtyHomeownersMobile Homeowner73706Premium FinanceOrganizationINDV1740AETNA LIFE INSURANCE COMPANYRelativeDenial Of ClaimNoAdditional Payment Expected; Information Furnished2012-07-05T00:00:002012-08-31T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured245Ins Co - Licensed/ActiveOrganizationINDV1741ATLANTIC CASUALTY INSURANCE COMPANYAttorneyDelays (Claims Handling)NoContract Language/Legal Issue2012-07-02T00:00:002012-11-28T00:00:00Property and CasualtyHomeownersHomeownersInsured; Third Party Admin-Licensed52002Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1742DELTA DENTAL INSURANCE COMPANYRelativeOtherNoNo Jurisdiction2012-07-05T00:00:002012-09-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HThird Party Admin-Licensed2752Ins Co - Licensed/ActiveOrganizationINDV1743ALLSTATE INDEMNITY COMPANYInsuredUse of Credit ReportsNoInformation Furnished2012-07-06T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent167Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA1744OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYAttorneyDelays (Claims Handling); Unsatisfactory Settle/OfferNoClaim Settled; Information Furnished2012-07-05T00:00:002012-09-21T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; GR-Claim Evaluation; TOTAL LOSS1746UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-07-06T00:00:002012-08-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; MULTIPLE INSUREDS1747SACKS, WILLIAM MInsuredOtherYesAdditional Monies Received; Failure to Timely Respond2012-07-09T00:00:002012-09-14T00:00:00Property and CasualtyMiscellaneousFidelity & SuretyAssociated Subject Company784954AgentIndividualINDV1748STATE FARM LLOYDSInsuredPremium and RatingNoInformation Furnished2012-07-05T00:00:002012-09-11T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent3105Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE; UNDERWRITING CRITERIA1753ACE AMERICAN INSURANCE COMPANYAttorneyDenial Of ClaimNoQuestion of Fact; Contract Language/Legal Issue2012-07-05T00:00:002012-09-13T00:00:00Property and CasualtyLiabilityGeneral LiabilityInsured Company2327Ins Co - Licensed/ActiveOrganizationORGBURDEN OF PROOF; COVERAGE DISPUTE1754HOME STATE COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoQuestion of Fact2012-07-06T00:00:002012-08-06T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured2362Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation1755CONSECO LIFE INSURANCE COMPANYInsuredMisrepresentationYesInformation Furnished; Contract Language/Legal Issue2012-07-05T00:00:002012-09-04T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2113Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN1756ALLSTATE INDEMNITY COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Question of Fact2012-07-09T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured167Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation1757DAIRYLAND COUNTY MUTUAL INSURANCE COMPANY OF TEXASThird PartyUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-07-06T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2737Ins Co - Licensed/ActiveOrganizationINDVAFTERMARKET PARTS1758VALASTRO, ELIZABETH ANNEInsuredUnauthorized ActsNoInsufficient Information2012-06-29T00:00:002012-08-30T00:00:00Property and CasualtyHomeownersHomeowners709843AgentIndividualINDV1759CENTRAL STATES HEALTH & LIFE CO. OF OMAHARelativeDenial Of Claim; Pre-Existing ConditionNoQuestion of Fact2012-07-05T00:00:002012-09-27T00:00:00Life, Accident and HealthLife & AnnuityCredit LifeInsured2909Ins Co - Licensed/ActiveOrganizationINDV1760PERMANENT GENERAL ASSURANCE CORPORATION OF OHIOThird PartyDelays (Claims Handling); Liability DisputeNoInformation Furnished; Additional Monies Received; Additional Payment Expected2012-07-09T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured25400Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; UNCOOPERATIVE INSURED1761ALLSTATE INDEMNITY COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-07-09T00:00:002012-09-17T00:00:00Property and CasualtyHomeownersHomeowners167Ins Co - Licensed/ActiveOrganizationINDVROOF; WATER DAMAGE1762UNITED OF OMAHA LIFE INSURANCE COMPANYOtherDelays (Claims Handling)NoAdditional Payment Expected; Information Furnished2012-07-06T00:00:002012-10-17T00:00:00Life, Accident and HealthLife & AnnuityGroup LifeInsured1281Ins Co - Licensed/ActiveOrganizationINDV1763PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished; Complainant Retained Attorney2012-07-05T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1708Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation1764FIRE INSURANCE EXCHANGEConsumer (Non-Insured)Agent HandlingNoCompany Position Upheld; Information Furnished2012-07-06T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners2606Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF; COVERAGE DISPUTE1765SOUTHWEST MARINE AND GENERAL INSURANCE COMPANYAttorneyUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-07-05T00:00:002012-09-12T00:00:00Property and CasualtyMiscellaneousFidelity & Surety33777Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1766ACCC INSURANCE COMPANYInsuredEndorsement / Rider; Refund Of PremiumNoInformation Furnished2012-07-06T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person9825Ins Co - Licensed/ReceivershipOrganizationINDV1766EKEADA, HENRYInsuredEndorsement / Rider; Refund Of PremiumNoInformation Furnished2012-07-06T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person625878AgentIndividualINDV1767Kerr County Abstract and Title CoThird PartyOtherNoCompany Position Upheld2012-07-06T00:00:002012-09-05T00:00:00Property and CasualtyMiscellaneousTitle InsuranceCorrespondent Person66984AgentOrganizationINDV1769OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYAttorneyDenial Of Claim; Liability DisputeNoCompany Position Upheld; Question of Fact; Information Furnished2012-07-10T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Correspondent Person; Insured35287Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; COVERAGE DISPUTE1770ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYRelativeDenial Of ClaimNoClaim Settled; Additional Monies Received; Information Furnished2012-07-10T00:00:002012-09-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person936Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation1771UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDelays (Claims Handling); Unsatisfactory Settle/OfferNoClaim Settled2012-07-06T00:00:002012-08-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV1772DIAMOND, DON MInsuredUnauthorized ActsNoInformation Furnished2012-07-10T00:00:002012-10-26T00:00:00Property and CasualtyLiabilityGeneral LiabilityAssociated Subject Company726325AgentIndividualINDV1773PACIFIC SPECIALTY INSURANCE COMPANYInsuredDelays (Claims Handling)NoContract Language/Legal Issue; Information Furnished2012-07-10T00:00:002012-09-13T00:00:00Property and CasualtyHomeownersHomeowners10237Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF1774SOUTHERN COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-07-10T00:00:002012-08-30T00:00:00Property and CasualtyHomeownersMobile Homeowner1583Ins Co - Licensed/ActiveOrganizationINDVWATER DAMAGE1775DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-07-10T00:00:002012-08-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1776SAFECO INSURANCE COMPANY OF INDIANAInsuredDenial Of Claim; Unsatisfactory Settle/OfferNoInformation Furnished2012-07-06T00:00:002012-08-31T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person2496Ins Co - Licensed/ActiveOrganizationINDVROOF; WATER DAMAGE1778MAXUM INDEMNITY COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-07-10T00:00:002012-08-31T00:00:00Property and CasualtyFire, Allied Lines & CMPBusiness Owners51979Ins Co - Licensed/ActiveOrganizationORGACV; HAIL; ROOF1779AETNA LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction2012-07-06T00:00:002012-08-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV1780Chicago Title InsurnaceInsuredDelays (Claims Handling)NoCompany Position Upheld2012-07-10T00:00:002012-08-16T00:00:00Property and CasualtyMiscellaneousTitle Insurance66988Ins Co - Licensed/ActiveOrganizationINDV1781AMERIPRISE AUTO & HOME INSURANCE AGENCY INCInsuredPremium and RatingNoCancellation Withdrawn; Policy Issued/Restored; Corrective Action Taken2012-07-10T00:00:002012-08-27T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company18598Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNDERWRITING CRITERIA1782ALLSTATE PROPERTY AND CASUALTY INSURANCE COMPANYInsuredDelays (Policyholder Service)NoInformation Furnished2012-07-10T00:00:002012-08-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass3463Ins Co - Licensed/ActiveOrganizationINDV1783ACCC INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoAdditional Monies Received2012-07-10T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDVDIMINISHED VALUE; GR-Claim Evaluation1785ASI LLOYDSInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished; Additional Monies Received2012-07-11T00:00:002012-10-16T00:00:00Property and CasualtyHomeownersHomeowners14728Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE; WATER DAMAGE1787BUSBY, RUTH FAgentAgent/Agency Contrct TerminYesOther2012-07-11T00:00:002012-10-10T00:00:00Property and CasualtyMiscellaneousInland MarineInsured Company247727AgentIndividualORG1789PHYSICIANS HEALTH CHOICE OF TEXAS, LLCProviderMedical NecessityNoClaim Settled2012-07-06T00:00:002012-11-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured17170Health Maintenance OrgOrganizationORG1790ARCADIAN HEALTH PLAN, INC.Contracted ProviderDenial Of Claim; Unsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-07-06T00:00:002012-10-21T00:00:00Health Maintenance OrgAccident and HealthGroup A&HAssociated Subject Company; Correspondent Person; Insured22588Health Maintenance OrgOrganizationORG1792GOVERNMENT EMPLOYEES INSURANCE COMPANYConsumer (Non-Insured)Unsatisfactory Settle/OfferNoQuestion of Fact2012-07-11T00:00:002012-08-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Insured2486Govermental EntityOrganizationINDVGR-Claim Evaluation1793BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction2012-07-06T00:00:002012-08-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG1794UNITED SERVICES AUTOMOBILE ASSOCIATIONInsuredExcessive Rates; Premium and RatingNoInformation Furnished; Company Position Upheld2012-07-11T00:00:002012-08-22T00:00:00Property and CasualtyAutomobileIndividual Private Pass1254Ins Co - Licensed/ActiveOrganizationINDVAGENT'S FEE1795BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-05T00:00:002012-09-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Self-Funded / ErisaOrganizationORG1796ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYConsumer (Non-Insured)Denial Of ClaimNoQuestion of Fact; Company Position Upheld2012-07-11T00:00:002012-10-16T00:00:00Property and CasualtyHomeownersHomeowners936Ins Co - Licensed/ActiveOrganizationINDVROOF1797AETNA LIFE INSURANCE COMPANYProviderDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-07-05T00:00:002012-09-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG1798STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYLienholderUnsatisfactory Settle/OfferYesInformation Furnished; Additional Payment Expected2012-07-11T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Correspondent Person1510Ins Co - Licensed/ActiveOrganizationINDV1799NEW YORK LIFE INSURANCE AND ANNUITY CORPORATIONInsuredCash ValueNoContract Language/Legal Issue; Information Furnished2012-07-05T00:00:002012-08-23T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life827Ins Co - Licensed/ActiveOrganizationINDV1800TRANSAMERICA LIFE INSURANCE COMPANYRelativeOtherNoInformation Furnished2012-07-06T00:00:002012-11-13T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesAssociated Subject Company; Insured1983Ins Co - Licensed/ActiveOrganizationINDV1802AETNA LIFE INSURANCE COMPANYInsuredBalance Billing; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-09T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation1803JEFFERS, DOUGLAS ALBERTRelativeOtherNoInsufficient Information2012-07-06T00:00:002012-10-24T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Person; Insured112167AgentIndividualINDVGR-Claim Evaluation1804PROPERTY AND CASUALTY INSURANCE COMPANY OF HARTFORDInsuredOvercharges; Premium and RatingNoInformation Furnished2012-07-11T00:00:002012-10-19T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent8123Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1806COLONIAL COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeNoCompany Position Upheld; Information Furnished2012-06-13T00:00:002012-08-06T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured2455Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1807PACIFIC SPECIALTY PROPERTY AND CASUALTY COMPANYInsuredDelays (Claims Handling)NoInformation Furnished; Additional Payment Expected2012-07-11T00:00:002012-10-02T00:00:00Property and CasualtyHomeownersHomeowners15084Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1808BOON-CHAPMAN BENEFIT ADMINISTRATORS, INC.ProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-11T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured136371Third Party AdministratorsOrganizationORG1809BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONPhysicianUnsatisfactory Settle/OfferNoNo Jurisdiction; Additional Payment Expected; Information Furnished2012-07-10T00:00:002012-08-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; DEDUCTIBLE; GR-Claim Evaluation1810Galaxy Aurto InsuranceInsuredOtherNoInformation Furnished; Premium Refunded2012-07-11T00:00:002012-09-21T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Associated Subject Person67068FM Unregistered CompanyOrganizationINDV1812NATIONAL GENERAL ASSURANCE COMPANYInsuredExcessive Rates; Premium and Rating; Use of Credit ReportsNoInformation Furnished; Contract Language/Legal Issue2012-07-11T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileIndividual Private Pass7765Ins Co - Licensed/ActiveOrganizationINDVCREDIT REPORT1813ESURANCE INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-07-11T00:00:002012-09-21T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person1350Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; AFTERMARKET PARTS; APPRAISAL; BURDEN OF PROOF; DAMAGE DISPUTE1814UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-07-09T00:00:002012-08-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation1816UNITED SERVICES AUTOMOBILE ASSOCIATIONThird PartyCust Service Claim Handling; Delays (Claims Handling)YesClaim Settled; Additional Monies Received2012-07-11T00:00:002012-08-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass1254Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED1817UMR, INC.ProviderDenial Of ClaimNoNo Jurisdiction2012-07-10T00:00:002012-11-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company23490Self-Funded / ErisaOrganizationORG1818OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)NoInformation Furnished2012-07-11T00:00:002012-09-14T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Associated Subject Person1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation1819ALLSTATE TEXAS LLOYD'SInsuredNon-RenewalNoInformation Furnished2012-07-11T00:00:002012-09-14T00:00:00Property and CasualtyHomeownersHomeowners3721Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA1820STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredAssignment of Benefits; Recoupment Of Claims PaymentNoInformation Furnished2012-07-11T00:00:002012-11-28T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Associated Subject Person; Insured1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1820GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredAssignment of Benefits; Recoupment Of Claims PaymentNoInformation Furnished2012-07-11T00:00:002012-11-28T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Associated Subject Person; Insured2486Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1821STATE FARM LLOYDSThird PartyUnsatisfactory Settle/OfferNoCompany Position Upheld; Additional Monies Received; Information Furnished2012-07-11T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeownersInsured3105Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation; HAIL; ROOF1822SAFECO INSURANCE COMPANY OF INDIANAInsuredRecoupment Of Claims PaymentNoInformation Furnished; Additional Monies Received; Company Position Upheld2012-07-11T00:00:002012-10-04T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company2496Ins Co - Licensed/ActiveOrganizationINDV1823SOUTHERN COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Question of Fact2012-07-11T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1583Ins Co - Licensed/ActiveOrganizationINDV1824OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoAdditional Monies Received; Claim Settled2012-07-11T00:00:002012-08-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; LOSS OF USE1826NATIONWIDE MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld; Question of Fact2012-07-11T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person1937Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF; GR-Claim Evaluation1827FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredCancellationNoCompany Position Upheld2012-07-11T00:00:002012-09-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; MULTIPLE INSUREDS; UNDERWRITING CRITERIA1827ALDOUS, WARREN LEEInsuredAgent Handling; Unauthorized ActsNoCancel/Non-Renewal Upheld2012-07-11T00:00:002012-09-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass147873AgentIndividualINDVCOVERAGE DISPUTE; MULTIPLE INSUREDS; UNDERWRITING CRITERIA1828ASI LLOYDSInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Claim Settled; Additional Monies Received2012-07-11T00:00:002012-09-12T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent14728Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; DAMAGE DISPUTE; MOLD; WATER DAMAGE1829AETNA LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoAdditional Monies Received2012-07-10T00:00:002012-08-14T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H245Ins Co - Licensed/ActiveOrganizationINDV1830AMERICAN NATIONAL INSURANCE COMPANYBeneficiaryCash Value; Delays (Policyholder Service)NoAdditional Payment Expected2012-07-11T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured135Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1831TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYThird PartyDenial Of Claim; Unsatisfactory Settle/OfferNoInformation Furnished2012-07-11T00:00:002012-09-07T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1450Ins Co - Licensed/ActiveOrganizationINDV1832GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Additional Monies Received; Claim Settled2012-07-11T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1833TRAVELERS LLOYDS OF TEXAS INSURANCE COMPANYThird PartyOtherNoQuestion of Fact; Contract Language/Legal Issue; Information Furnished2012-07-11T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent776Ins Co - Licensed/ActiveOrganizationINDV1834McMillian, MattConsumer (Non-Insured)Misleading AdvertisingNoInformation Furnished; Corrective Action Taken2012-07-11T00:00:002012-09-11T00:00:00Property and CasualtyHomeownersHomeowners1131705AgentIndividualINDVADVERTISING1835UMR, INC.ProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-10T00:00:002012-08-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured23490Third Party AdministratorsOrganizationORG1836OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferYesQuestion of Fact2012-07-11T00:00:002012-08-31T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation1837Mastercraft RoofingConsumer (Non-Insured)OtherNoOther2012-07-11T00:00:002012-10-19T00:00:00Property and CasualtyHomeownersHomeownersCorrespondent Company; Insured; Insured Company67088ProviderOrganizationINDV1838AETNA LIFE INSURANCE COMPANYPhysicianOtherNoInformation Furnished2012-07-10T00:00:002013-02-15T00:00:00Life, Accident and HealthMiscellaneousNo Line Specified245Ins Co - Licensed/ActiveOrganizationINDV1839ALLSTATE INDEMNITY COMPANYInsuredPremium and RatingNoCompany Position Upheld; Information Furnished2012-07-11T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent167Ins Co - Licensed/ActiveOrganizationINDV1840GRAMERCY INSURANCE COMPANYLienholderDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; Company Position Upheld2012-07-11T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Correspondent Person; Insured1062Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING1843STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXASInsuredUse of Credit ReportsNoInformation Furnished2012-07-11T00:00:002012-08-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent1506Ins Co - Licensed/ActiveOrganizationINDVCREDIT REPORT1844GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredDelays (Claims Handling); Denial Of Claim; Unfair Discrim-Clms HandlingNoInformation Furnished2012-07-11T00:00:002012-09-07T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVACV; TOTAL LOSS1845NORTH AMERICAN COMPANY FOR LIFE AND HEALTH INSURANCEAgentOtherNoInformation Furnished2012-07-10T00:00:002012-09-26T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesInsured1899Ins Co - Licensed/ActiveOrganizationINDV1846UNITED AMERICAN INSURANCE COMPANYConsumer (Non-Insured)Unsatisfactory Settle/OfferNo2012-04-23T00:00:002012-05-21T00:00:00Life, Accident and HealthLife & AnnuityXX-State Specific801Ins Co - Licensed/ActiveOrganizationINDV1846AMERICAN ASSOCIATION FOR MEDICAL BENEFITSConsumer (Non-Insured)OverchargesNoOther2012-04-23T00:00:002012-05-21T00:00:00Life, Accident and HealthLife & AnnuityXX-State Specific37536OtherOrganizationINDV1847HOCHHEIM PRAIRIE FARM MUTUAL INSURANCE ASSOCIATIONInsuredPremium and RatingNoCompany Position Upheld2012-07-11T00:00:002012-09-28T00:00:00Property and CasualtyHomeownersHomeowners2350Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN; UNDERWRITING CRITERIA1847STOKES, KEVIN JInsuredAgent HandlingNoInformation Furnished2012-07-11T00:00:002012-09-28T00:00:00Property and CasualtyHomeownersHomeowners207812AgentIndividualINDVSENIOR CITIZEN; UNDERWRITING CRITERIA1849TRAVELERS LLOYDS OF TEXAS INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferYesInformation Furnished; Question of Fact; Additional Payment Expected2012-07-11T00:00:002012-10-16T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person776Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; HAIL1850ALLSTATE INDEMNITY COMPANYInsuredEndorsement / Rider; Refund Of PremiumYesCorrective Action Taken; Additional Monies Received2012-07-11T00:00:002012-09-07T00:00:00Property and CasualtyAutomobileIndividual Private Pass167Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE1851SAFECO INSURANCE COMPANY OF INDIANAInsuredPremium and RatingNoCompany Position Upheld2012-07-11T00:00:002012-09-06T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company2496Ins Co - Licensed/ActiveOrganizationINDV1852GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Corrective Action Taken2012-07-10T00:00:002012-09-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationORG1853AMERICAN MEDICAL AND LIFE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-07-02T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Agency; Associated Subject Company74Ins Co - Licensed/ActiveOrganizationINDV1853JOHNSON, GARY WAYNEInsuredMisrepresentationNoInformation Furnished2012-07-02T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Agency; Associated Subject Company430737AgentIndividualINDV1854TEXAS FARM BUREAU CASUALTY INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-07-10T00:00:002012-10-13T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Person28440Ins Co - Licensed/ActiveOrganizationINDV1855TEXAS FARMERS INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoCompany Position Upheld; Additional Payment Expected; Information Furnished2012-07-11T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeownersInsured1452Ins Co - Licensed/ActiveOrganizationORGAPPRAISAL; GR-Claim Evaluation; HAIL; OVERHEAD AND PROFIT; ROOF1858WESTERN GENERAL AUTOMOBILE INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)NoContract Language/Legal Issue2012-07-11T00:00:002012-08-31T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person9738Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED1859UNITEDHEALTHCARE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished2012-07-10T00:00:002012-08-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV1860AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-09T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG1861UNITEDHEALTHCARE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-07-11T00:00:002012-09-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV1862FREEDOM LIFE INSURANCE COMPANY OF AMERICAInsuredDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-07-11T00:00:002012-09-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2855Ins Co - Licensed/ActiveOrganizationINDV1863AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesAdditional Monies Received; Stat Pen Pd-Over 90 Dys Late2012-07-11T00:00:002012-08-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG1864NATIONWIDE AGRIBUSINESS INSURANCE COMPANYInsuredPremium NoticeNoInformation Furnished; Company Position Upheld2012-07-11T00:00:002012-09-25T00:00:00Property and CasualtyAutomobileIndividual Private Pass2624Ins Co - Licensed/ActiveOrganizationINDV1866DENTICARE, INC.ProviderDenial Of ClaimNoInformation Furnished; Additional Monies Received2012-07-11T00:00:002012-08-20T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Person; Insured3712Health Maintenance OrgOrganizationORG1867American Home GuardianInsuredCust Service Claim Handling; Delays (Claims Handling)NoNo Jurisdiction; Referred To2012-07-11T00:00:002012-09-27T00:00:00Property and CasualtyHomeownersHomeownersInsured67099OtherOrganizationINDVADJUSTER'S HANDLING1868LOYA INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Question of Fact; Contract Language/Legal Issue2012-07-11T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured15643Ins Co - Licensed/ActiveOrganizationORGBURDEN OF PROOF; COMPARATIVE NEGLIGENCE1869BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONRelativeUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-11T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV1870ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-07-11T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF; DEDUCTIBLE1871HARTFORD LIFE AND ACCIDENT INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction; Contract Language/Legal Issue2012-05-17T00:00:002012-08-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HThird Party Admin-Licensed2383Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1871ASSOCIATION AND SOCIETY INSURANCE CORPORATIONInsuredPre-Existing ConditionNoOther; Company Position Upheld2012-05-17T00:00:002012-08-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HThird Party Admin-Licensed52036Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1872FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredLiability Dispute; Premium and RatingNoQuestion of Fact2012-07-11T00:00:002012-08-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1874TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredRefund Of PremiumNoInformation Furnished; Additional Monies Received2012-07-11T00:00:002012-08-31T00:00:00Property and CasualtyHomeownersHomeowners1444TWIAOrganizationINDV1875OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoQuestion of Fact; Information Furnished2012-07-11T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private PassThird Party Admin-Non Licensed1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation1876HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredLiability DisputeNoContract Language/Legal Issue; Information Furnished2012-07-11T00:00:002012-09-21T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company2362Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF1878PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-07-11T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA1879OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYConsumer (Non-Insured)Denial Of ClaimNoQuestion of Fact; Company Position Upheld; Information Furnished2012-07-11T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Associated Subject Person; Insured1823Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation1880GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling); Denial Of ClaimNoQuestion of Fact; Additional Monies Received2012-07-11T00:00:002012-11-16T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent2486Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation1881LOYA INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Claim Settled2012-07-11T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured15643Ins Co - Licensed/ActiveOrganizationINDV1883ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld2012-07-11T00:00:002012-10-17T00:00:00Property and CasualtyHomeownersHomeowners936Ins Co - Licensed/ActiveOrganizationINDVAPPRAISAL; DEDUCTIBLE; GR-Claim Evaluation; HAIL; ROOF1884BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredPremium and RatingNoCorrective Action Taken2012-07-11T00:00:002012-10-14T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationINDV1885BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUsual And CustomaryNoClaim Settled2012-07-13T00:00:002012-08-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company10047Ins Co - Licensed/ActiveOrganizationINDV1886OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Company Position Upheld; Question of Fact2012-07-11T00:00:002012-09-20T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DRIVER NOT COVERED; GR-Claim Evaluation1887STATE FARM LLOYDSInsuredPremium NoticeNoInformation Furnished2012-07-11T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent3105Ins Co - Licensed/ActiveOrganizationINDV1888PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld; Question of Fact2012-07-11T00:00:002012-09-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation1889WELLINGTON INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Payment Expected; Additional Monies Received; Contract Language/Legal Issue2012-07-11T00:00:002012-10-31T00:00:00Property and CasualtyHomeownersHomeowners18251Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF; HAIL; ROOF; WATER DAMAGE1890LOYA INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Additional Monies Received2012-07-12T00:00:002012-09-04T00:00:00Property and CasualtyAutomobileIndividual Private PassCorrespondent Person; Insured15643Ins Co - Licensed/ActiveOrganizationINDV1892ESCALANTE, ELISA HInsurance CompanyAgency BalanceYesOther2012-07-05T00:00:002012-08-20T00:00:00Life, Accident and HealthMiscellaneousNo Line Specified575162AgentIndividualORG1893BAEZ-HINOJOSA, ERICA LAISEInsurance CompanyAgency BalanceYesOther2012-07-05T00:00:002012-08-17T00:00:00Property and CasualtyMiscellaneousNo Line Specified1091219AgentIndividualORG1894SOUTHWEST SERVICE LIFE INSURANCE COMPANYInsuredRefund Of PremiumNoContract Language/Legal Issue2012-07-11T00:00:002012-10-14T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Agent1542Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE1895GENERAL INSURANCE COMPANY OF AMERICAInsuredLiability DisputeNoInformation Furnished2012-07-12T00:00:002012-09-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass2508Ins Co - Licensed/ActiveOrganizationINDVCOMPARATIVE NEGLIGENCE; GR-Claim Evaluation; TOTAL LOSS1896JOHNSON, BLAIR NICOLEInsurance CompanyAgency BalanceYesOther2012-07-05T00:00:002012-08-17T00:00:00Property and CasualtyMiscellaneousNo Line Specified983307AgentIndividualORG1897STEWART TITLE GUARANTY COMPANYInsuredDelays (Claims Handling)NoAdditional Payment Expected2012-07-12T00:00:002012-08-16T00:00:00Property and CasualtyMiscellaneousTitle Insurance48783Ins Co - Licensed/ActiveOrganizationORG1898JIMENEZ, MAEGAN AMANDAInsurance CompanyAgency BalanceYesOther2012-07-05T00:00:002012-09-18T00:00:00Property and CasualtyMiscellaneousNo Line Specified787051AgentIndividualORG1899ALLSTATE TEXAS LLOYD'SInsuredDenial Of ClaimNoInformation Furnished; Question of Fact2012-07-11T00:00:002012-10-24T00:00:00Property and CasualtyHomeownersHomeowners3721Ins Co - Licensed/ActiveOrganizationINDVENGINEER'S REPORT; GR-Claim Evaluation; ROOF1900NATIONAL SPECIALTY INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoAppraisal Process Invoked; Additional Payment Expected; Information Furnished2012-07-12T00:00:002012-09-17T00:00:00Property and CasualtyHomeownersHomeowners2281Ins Co - Licensed/ActiveOrganizationINDVHAIL; ROOF1901OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received; Question of Fact2012-07-12T00:00:002012-09-04T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; LOSS OF USE1902AMERICAN FAMILY LIFE ASSURANCE COMPANY OF COLUMBUSInsuredDelays (Claims Handling)NoInformation Furnished; Additional Monies Received2012-07-11T00:00:002012-08-13T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2655Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1903GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyDelays (Claims Handling)NoComplainant Retained Attorney; Question of Fact2012-07-12T00:00:002012-09-04T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company2486Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation1904METROPOLITAN LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-11T00:00:002012-09-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured13191Ins Co - Licensed/ActiveOrganizationINDV1905OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)NoAdditional Monies Received; Claim Settled2012-07-12T00:00:002012-09-05T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1906BRISTOL WEST SPECIALTY INSURANCE COMPANYInsuredOtherNoInformation Furnished; Question of Fact2012-07-12T00:00:002012-09-14T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person8129Ins Co - Licensed/ActiveOrganizationINDV1907OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoAdditional Payment Expected; Information Furnished2012-07-12T00:00:002012-10-02T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1909TEXAS FARMERS INSURANCE COMPANYInsuredPremium and RatingNoPremium Refunded2012-07-12T00:00:002012-08-22T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE1909RITCHEY, PATSY LInsuredAgent HandlingYesPremium Refund; Additional Monies Received2012-07-12T00:00:002012-08-22T00:00:00Property and CasualtyHomeownersHomeowners382443AgentIndividualINDVCOVERAGE DISPUTE1910PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYConsumer (Non-Insured)Cust Service Claim Handling; Denial Of ClaimNoInformation Furnished; Policy Not In Force2012-07-12T00:00:002012-09-20T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1708Ins Co - Licensed/ActiveOrganizationORG1911TEXAS FARMERS INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished2012-07-09T00:00:002012-09-24T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; OVERHEAD AND PROFIT; ROOF1912USAgencies Casualty Insurance CompanyAttorneyDelays (Claims Handling)NoNo Jurisdiction; Claim Settled2012-07-12T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private Pass75734OtherOrganizationINDVADJUSTER'S HANDLING1913SOUTHWEST LIFE & HEALTH INSURANCE COMPANYProviderDenial Of ClaimNoContract Language/Legal Issue2012-07-11T00:00:002012-08-28T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured2041Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation1914SAFE AUTO INSURANCE COMPANYConsumer (Non-Insured)Unsatisfactory Settle/OfferNoAdditional Monies Received; Claim Settled2012-07-12T00:00:002012-09-05T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured25980Ins Co - Licensed/ActiveOrganizationORG1915ASI LLOYDSOtherUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-07-12T00:00:002012-09-11T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person; Insured14728Ins Co - Licensed/ActiveOrganizationINDVHAIL; OVERHEAD AND PROFIT; ROOF; SUPPLEMENTARY PAYMENT1916GOVERNMENT EMPLOYEES INSURANCE COMPANYConsumer (Non-Insured)Delays (Claims Handling)NoInformation Furnished; Company Position Upheld2012-07-12T00:00:002012-09-10T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2486Ins Co - Licensed/ActiveOrganizationORGSUPPLEMENTARY PAYMENT1917AMERICAN FAMILY LIFE ASSURANCE COMPANY OF COLUMBUSInsuredDelays (Claims Handling)NoContract Language/Legal Issue; Information Furnished; Additional Payment Expected2012-07-11T00:00:002012-08-14T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2655Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1918CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderTimely Filing Deficiency; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-11T00:00:002012-08-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation1919Alamo Title CompanyConsumer (Non-Insured)OtherNoCompany Position Upheld2012-07-11T00:00:002012-09-19T00:00:00Property and CasualtyMiscellaneousTitle InsuranceAssociated Subject Company; Associated Subject Person68113AgentOrganizationINDV1920AMERICAN NATIONAL INSURANCE COMPANYInsuredCash Value; Delays (Policyholder Service)NoAdditional Monies Received; Information Furnished2012-07-11T00:00:002012-08-13T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life135Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1921CONSUMERS COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Additional Payment Expected2012-07-11T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person2806Ins Co - Licensed/ActiveOrganizationINDV1922STATE FARM LLOYDSInsuredUnsatisfactory Settle/OfferYesCompany Position Upheld2012-07-09T00:00:002012-10-22T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVROOF1923AIM ADMINISTRATORS, LTD.ProviderCust Service Claim HandlingYesInsufficient Information2012-07-11T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured24472Third Party AdministratorsOrganizationORGGR-Claim Evaluation1924SAFECO INSURANCE COMPANY OF AMERICAInsuredCust Service Claim HandlingNoAdditional Payment Expected2012-07-13T00:00:002012-09-18T00:00:00Property and CasualtyHomeownersHomeowners1619Ins Co - Licensed/ActiveOrganizationINDV1926UNITEDHEALTHCARE INSURANCE COMPANYRelativeCoordination of Benefits; Denial Of ClaimNoInformation Furnished; No Jurisdiction2012-07-11T00:00:002012-08-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDVPRESCRIPTION1927ACCC INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoAdditional Payment Expected; Question of Fact2012-07-12T00:00:002012-08-01T00:00:00Property and CasualtyAutomobileIndividual Private PassGR Elected Official9825Ins Co - Licensed/ActiveOrganizationINDV1928UNITEDHEALTHCARE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-11T00:00:002012-09-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV1929CONNECTICUT GENERAL LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoAdditional Monies Received2012-07-11T00:00:002012-09-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Ins Co - Licensed/ActiveOrganizationINDV1930HUMANA INSURANCE COMPANYInsuredMedical Necessity; Unsatisfactory Settle/OfferNoInformation Furnished2012-07-03T00:00:002012-08-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationINDV1932HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferNoInformation Furnished2012-06-15T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass2362Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation1933AETNA HEALTH INC.Contracted ProviderDenial Of ClaimYesAdditional Monies Received; Information Furnished2012-07-10T00:00:002012-10-30T00:00:00Health Maintenance OrgAccident and HealthIndividual A & HInsured3522Health Maintenance OrgOrganizationINDV1934UNITEDHEALTHCARE OF TEXAS, INC.ProviderClaim Recoding/Bundling; Unsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-07-06T00:00:002012-08-17T00:00:00Employee Retirement SystemAccident and HealthGroup A&HCorrespondent Person3363Health Maintenance OrgOrganizationORG1935PAUL, TIMOTHY LEEOtherUnauthorized ActsYesInformation Furnished2012-07-06T00:00:002012-09-11T00:00:00Property and CasualtyMiscellaneousNo Line Specified347573AgentIndividualINDV1937NATIONAL PACIFIC DENTAL, INC.InsuredDelays In AuthorizationYesAdditional Payment Expected2012-07-10T00:00:002012-08-22T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Person; Insured3669Health Maintenance OrgOrganizationINDV1938RATTIKIN TITLE COMPANYConsumer (Non-Insured)Title RebatesNoCompany Position Upheld2012-07-09T00:00:002012-09-11T00:00:00Property and CasualtyMiscellaneousTitle Insurance66899AgentOrganizationINDV1939HOME STATE COUNTY MUTUAL INSURANCE COMPANYConsumer (Non-Insured)Denial Of ClaimNoInformation Furnished; Company Position Upheld2012-07-06T00:00:002012-09-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass2362Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED1940HUMANA INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction2012-07-10T00:00:002012-10-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationINDVPRESCRIPTION1941UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNo2012-07-10T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG1941UNITED HEALTHCARE SERVICES, INC.ProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-10T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured36825Third Party AdministratorsOrganizationORG1943AMERICAN MEDICAL AND LIFE INSURANCE COMPANYInsuredRefund Of PremiumNoInformation Furnished; Contract Language/Legal Issue2012-07-10T00:00:002012-09-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company74Ins Co - Licensed/ActiveOrganizationINDV1946SAFECO INSURANCE COMPANY OF AMERICAThird PartyDelays (Claims Handling)YesInformation Furnished; Complainant Retained Attorney2012-07-12T00:00:002012-09-19T00:00:00Property and CasualtyMiscellaneousFidelity & SuretyCorrespondent Company; Correspondent Person; Insured Company1619Ins Co - Licensed/ActiveOrganizationINDV1947DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferYesAdditional Payment Expected; Information Furnished; Additional Monies Received2012-07-06T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation1948BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredCancellationNoNo Jurisdiction2012-07-11T00:00:002012-09-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company10047Ins Co - Licensed/ActiveOrganizationINDV1949ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredRefund Of PremiumNoInformation Furnished; Contract Language/Legal Issue2012-07-06T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDV1952BURLINGTON INSURANCE COMPANY, THEThird PartyCust Service Claim Handling; Delays (Claims Handling)NoQuestion of Fact; Additional Payment Expected; Information Furnished2012-07-09T00:00:002012-10-12T00:00:00Property and CasualtyLiabilityGeneral LiabilityAssociated Subject Company; Associated Subject Person51841Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1953FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Question of Fact2012-07-06T00:00:002013-01-17T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured2623Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1954LOYAL AMERICAN LIFE INSURANCE COMPANYRelativePremium and Rating; Refund Of PremiumNoRate Problem Resolved2012-07-16T00:00:002012-07-18T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2129Ins Co - Licensed/ActiveOrganizationINDV1955LIBERTY INSURANCE CORPORATIONInsuredLiability DisputeNoQuestion of Fact; Information Furnished2012-07-09T00:00:002012-08-16T00:00:00Property and CasualtyHomeownersHomeowners3636Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF; GR-Claim Evaluation1956STATE FARM LLOYDSInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld2012-07-09T00:00:002012-10-02T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1957USAA CASUALTY INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling)NoCompany Position Upheld2012-07-09T00:00:002012-10-01T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person3607Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1958LINCOLN HERITAGE LIFE INSURANCE COMPANYInsuredDenial Of Claim; Pre-Existing ConditionNoContract Language/Legal Issue2012-07-10T00:00:002012-11-26T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life3467Ins Co - Licensed/ActiveOrganizationINDV1959R.V.O.S. FARM MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld; Contract Language/Legal Issue2012-07-09T00:00:002012-10-03T00:00:00Property and CasualtyHomeownersHomeowners2621Ins Co - Licensed/ActiveOrganizationINDV1960CAPITOL COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-07-09T00:00:002012-10-22T00:00:00Property and CasualtyHomeownersHomeowners2992Ins Co - Licensed/ActiveOrganizationINDVROOF; SENIOR CITIZEN; WATER DAMAGE1961UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-07-06T00:00:002012-08-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured1348Ins Co - Licensed/ActiveOrganizationORGBUNDLING1962VISION INSURANCE COMPANYAttorneyDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-07-09T00:00:002012-09-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass23478Ins Co - Licensed/ActiveOrganizationORGUNCOOPERATIVE INSURED1964UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-07-06T00:00:002012-08-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationORGBUNDLING1965JEFFERSON INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld2012-07-09T00:00:002012-10-03T00:00:00Property and CasualtyMiscellaneousP & C Misc2275Ins Co - Licensed/ActiveOrganizationINDV1965WORLD ACCESS SERVICE CORP.InsuredDenial Of ClaimNo2012-07-09T00:00:002012-10-03T00:00:00Property and CasualtyMiscellaneousP & C Misc16601OtherOrganizationINDV1966UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-07-06T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured1348Ins Co - Licensed/ActiveOrganizationORGBUNDLING1967SAFECO LLOYDS INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-07-09T00:00:002012-09-14T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Insured3223Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING1968PROPERTY AND CASUALTY INSURANCE COMPANY OF HARTFORDInsuredDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-07-09T00:00:002012-09-18T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person8123Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1969HALLMARK INSURANCE COMPANYInsuredPremium NoticeNoQuestion of Fact2012-07-09T00:00:002012-11-01T00:00:00Property and CasualtyAutomobileBusiness AutomobileAssociated Agent; Associated Subject Company24193Ins Co - Licensed/ActiveOrganizationORG1969TCL InsuranceInsuredRefund Of PremiumNoPremium Refunded2012-07-09T00:00:002012-11-01T00:00:00Property and CasualtyAutomobileBusiness AutomobileAssociated Agent; Associated Subject Company67187AgentOrganizationORG1970DEARBORN NATIONAL LIFE INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferYesAdditional Monies Received2012-07-12T00:00:002012-09-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&HGR Elected Official1013Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1971LOYA INSURANCE COMPANYLienholderCust Service Claim HandlingYesInformation Furnished; Claim Settled2012-07-09T00:00:002012-09-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass15643Ins Co - Licensed/ActiveOrganizationINDV1975OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDenial Of ClaimYesInformation Furnished; Additional Payment Expected2012-07-09T00:00:002012-09-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation1976GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredPremium and RatingNoCompany Position Upheld2012-07-10T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDV1977STEWART TITLE GUARANTY COMPANYInsuredDenial Of ClaimNoCompany Position Upheld2012-07-09T00:00:002012-08-28T00:00:00Property and CasualtyMiscellaneousTitle Insurance48783Ins Co - Licensed/ActiveOrganizationINDV1978AMERICAN NATIONAL COUNTY MUTUAL INSURANCE COMPANYInsuredUse of Credit ReportsNoCompany Position Upheld2012-07-10T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass2280Ins Co - Licensed/ActiveOrganizationINDVCREDIT REPORT; SENIOR CITIZEN1979OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDenial Of ClaimNoPolicy Not In Force; Company Position Upheld; Information Furnished2012-07-09T00:00:002012-09-14T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1823Ins Co - Licensed/ActiveOrganizationINDV1980AAA TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredExcessive Rates; Premium and RatingNoCorrective Action Taken; Premium Refunded2012-07-10T00:00:002012-10-01T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent2286Ins Co - Licensed/ActiveOrganizationINDV1981LANDMARK LIFE INSURANCE COMPANYInsuredXX-Payment Not CreditedNoInformation Furnished; Contract Language/Legal Issue2012-07-09T00:00:002012-09-17T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2191Ins Co - Licensed/ActiveOrganizationINDV1982STATE FARM LLOYDSThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoClaim Settled; Additional Monies Received2012-07-11T00:00:002012-09-24T00:00:00Property and CasualtyHomeownersHomeownersInsured3105Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation; ROOF; WATER DAMAGE1983UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDenial Of ClaimYesInformation Furnished2012-07-09T00:00:002012-08-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV1984INFINITY COUNTY MUTUAL INSURANCE COMPANYThird PartyLiability Dispute; Unsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-07-12T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1197Ins Co - Licensed/ActiveOrganizationINDVCOMPARATIVE NEGLIGENCE; GR-Claim Evaluation1985SAFECO INSURANCE COMPANY OF INDIANAOtherDelays (Claims Handling)NoAdditional Monies Received; Claim Settled2012-07-11T00:00:002012-10-12T00:00:00Property and CasualtyHomeownersHomeownersInsured2496Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; GR-Claim Evaluation; OVERHEAD AND PROFIT1986AETNA LIFE INSURANCE COMPANYInsuredCancellation; Premium and RatingNoInformation Furnished; Contract Language/Legal Issue2012-07-09T00:00:002012-10-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG1987LIBERTY COUNTY MUTUAL INSURANCE COMPANYInsuredRefund Of PremiumNoInformation Furnished; Company Position Upheld2012-07-11T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private Pass3762Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA1988ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Question of Fact2012-07-11T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured936Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; TOTAL LOSS1989Vermont Mutual Insurance CompanyThird PartyDelays (Claims Handling)NoAdditional Payment Expected; Information Furnished; Question of Fact2012-07-11T00:00:002013-03-28T00:00:00Property and CasualtyAutomobileIndividual Private PassGR Elected Official67196Ins Co - Licensed/ActiveOrganizationINDV1990SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.Injured EmployeeContinuity Of Treatment; Not Within TDI JurisdictionNoInformation Furnished; No Jurisdiction2012-07-11T00:00:002013-01-08T00:00:00Workers' CompensationMiscellaneousWC Non-InsuredAssociated Subject Person; Correspondent Company; Correspondent Person34661Third Party AdministratorsOrganizationINDVPRESCRIPTION1992GREAT AMERICAN LIFE INSURANCE COMPANYInsuredDelays (Policyholder Service)YesInformation Furnished; Corrective Action Taken2012-07-09T00:00:002012-10-17T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities720Ins Co - Licensed/ActiveOrganizationINDV1993SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.AttorneyUnsatisfactory Settle/OfferNoClaim Settled; Question of Fact2012-07-13T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass34661Ins Co - Licensed/ActiveOrganizationINDV1994AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoClaim Not Clean; Information Furnished2012-07-09T00:00:002012-08-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured245Ins Co - Licensed/ActiveOrganizationORG1995AUTO CLUB INDEMNITY COMPANYInsuredUnsatisfactory Settle/OfferNoQuestion of Fact2012-07-12T00:00:002012-09-04T00:00:00Property and CasualtyHomeownersHomeowners8776Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE; GR-Claim Evaluation1996DRIVER'S INSURANCE COMPANYThird PartyDenial Of ClaimNoContract Language/Legal Issue2012-07-12T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2038Ins Co - Licensed/ActiveOrganizationINDV1997HUMANA INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-10T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1040Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN2000STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYAttorneyDelays (Claims Handling)NoInformation Furnished2012-07-12T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationORG2001UNITED STATES FIRE INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished2012-07-09T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company50626Ins Co - Licensed/ActiveOrganizationINDV2002MGA INSURANCE COMPANY, INC.InsuredDenial Of ClaimNoAdditional Monies Received2012-07-12T00:00:002012-08-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass812Ins Co - Licensed/ActiveOrganizationINDV2003ALLSTATE INDEMNITY COMPANYThird PartyUnsatisfactory Settle/OfferNoQuestion of Fact2012-07-12T00:00:002012-09-05T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured167Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; LOSS OF USE2004STATE AUTOMOBILE MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-07-12T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileIndividual Private Pass26673Ins Co - Licensed/ActiveOrganizationINDVDIMINISHED VALUE; GR-Claim Evaluation2005BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoNo Jurisdiction2012-07-11T00:00:002012-08-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company10047Ins Co - Licensed/ActiveOrganizationINDV2007STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyUnfair Discrim-Clms HandlingNoCompany Position Upheld; Information Furnished2012-07-09T00:00:002012-10-01T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV2008A-AFFORDABLE INSURANCE AGENCY, INC.InsuredAgent HandlingNoInformation Furnished; Premium Refunded2012-07-12T00:00:002012-09-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent15268Insurance AgencyOrganizationINDV2008AMERICAN ACCESS CASUALTY COMPANYInsuredCancellation; Refund Of PremiumNoInformation Furnished; Cancel/Non-Renewal Upheld2012-07-12T00:00:002012-09-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent30332Ins Co - Licensed/ActiveOrganizationINDV2009RELIABLE LIFE INSURANCE COMPANY, THERelativeAssignment of Benefits; Cust Service Claim HandlingNoAdditional Monies Received2012-07-11T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured1704Ins Co - Licensed/ActiveOrganizationINDV2010AETNA LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-11T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDV2011AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Question of Fact2012-07-11T00:00:002012-08-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG2012GREEN TREE SERVICINGInsuredOtherNoInformation Furnished; Company Position Upheld2012-07-12T00:00:002012-09-11T00:00:00Property and CasualtyHomeownersHomeowners67436Mortgage LenderOrganizationINDV2013HUMANA INSURANCE COMPANYInsuredDenial Of Claim; Pre-Existing ConditionNoContract Language/Legal Issue; Information Furnished2012-07-11T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationINDV2016GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished2012-07-12T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDV2017HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.ProviderDenial Of ClaimNoNo Jurisdiction2012-07-11T00:00:002012-11-08T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company; Insured27417Ins Co - Licensed/ActiveOrganizationORG2018UNITED SERVICES AUTOMOBILE ASSOCIATIONAttorneyDelays (Claims Handling); Unfair Discrim-Clms Handling; Unsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-07-11T00:00:002012-09-10T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured1254Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING2019TEXAS FARMERS INSURANCE COMPANYInsuredDenial Of Claim; Unsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-07-12T00:00:002012-09-11T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF; WATER DAMAGE2020PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredCust Service Claim Handling; Denial Of ClaimNoContract Language/Legal Issue2012-07-12T00:00:002012-09-20T00:00:00Property and CasualtyAutomobileBusiness Automobile1708Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2021AETNA LIFE INSURANCE COMPANYInsuredDenial Of ClaimNo2012-07-11T00:00:002012-09-19T00:00:00Health Maintenance OrgAccident and HealthGroup A&HAssociated Subject Company245Ins Co - Licensed/ActiveOrganizationINDV2021AETNA HEALTH INC.InsuredCancellation; Denial Of ClaimNoInformation Furnished2012-07-11T00:00:002012-09-19T00:00:00Health Maintenance OrgAccident and HealthGroup A&HAssociated Subject Company3522Ins Co - Licensed/ActiveOrganizationINDV2025GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Claim Settled2012-07-13T00:00:002012-10-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVTOTAL LOSS2029UNITED SERVICES AUTOMOBILE ASSOCIATIONInsuredDenial Of ClaimNoContract Language/Legal Issue; Information Furnished; Question of Fact2012-07-12T00:00:002012-10-10T00:00:00Property and CasualtyHomeownersHomeowners1254Ins Co - Licensed/ActiveOrganizationINDVHAIL; ROOF2030PRESERVER INSURANCE COMPANYThird PartyUsual And CustomaryNoClaim Settled; Information Furnished2012-07-13T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileBusiness Automobile33845Ins Co - Licensed/ActiveOrganizationINDV2031STATE FARM LLOYDSInsuredCancellationNoCompany Position Upheld2012-07-13T00:00:002012-09-10T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDV2032TEXAS FAIR PLAN ASSOCIATIONInsuredDenial Of ClaimYesPolicy Issued/Restored2012-07-12T00:00:002012-11-20T00:00:00Property and CasualtyHomeownersHomeowners18208Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; ROOF2032PHENIX, DOUGLAS RAYInsuredAgent HandlingYesAdditional Payment Expected; Additional Monies Received2012-07-12T00:00:002012-11-20T00:00:00Property and CasualtyHomeownersHomeowners170462AgentIndividualINDVCOVERAGE DISPUTE; ROOF2033KEMPER INDEPENDENCE INSURANCE COMPANYInsuredDelays (Claims Handling)NoAdditional Monies Received; Company Position Upheld; Information Furnished2012-07-13T00:00:002012-10-19T00:00:00Property and CasualtyHomeownersHomeownersInsured9006Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; HAIL; ROOF; WATER DAMAGE2037OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYAttorneyCust Service Claim Handling; Delays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-07-13T00:00:002012-11-06T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Correspondent Person; Insured1823Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING2039OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDenial Of ClaimYesCompany Position Upheld2012-07-13T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation2041REASSURE AMERICA LIFE INSURANCE COMPANYAgentMisrepresentationNoInformation Furnished; Contract Language/Legal Issue2012-07-13T00:00:002012-08-24T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Agent; Insured1228Ins Co - Licensed/ActiveOrganizationINDV2042AETNA LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-11T00:00:002012-08-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationORG2043BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-17T00:00:002012-08-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2044CENTRAL STATES INDEMNITY CO. OF OMAHAInsuredRefund Of PremiumNoInformation Furnished; Premium Refunded2012-07-11T00:00:002012-10-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&H3300Ins Co - Licensed/ActiveOrganizationINDV2045OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received; Claim Settled2012-07-09T00:00:002012-10-01T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; LOSS OF USE2046UNITEDHEALTHCARE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-12T00:00:002012-09-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV2050ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished2012-07-13T00:00:002012-09-20T00:00:00Property and CasualtyHomeownersHomeowners936Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF2051UNDERWRITERS AT LLOYD'S, LONDONInsuredDelays (Claims Handling)NoInformation Furnished; Contract Language/Legal Issue2012-07-09T00:00:002012-11-02T00:00:00Property and CasualtyAutomobileBusiness Automobile55949Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2053STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYConsumer (Non-Insured)OtherNoInformation Furnished2012-07-13T00:00:002012-10-10T00:00:00Property and CasualtyMiscellaneousNo Line Specified1510Ins Co - Licensed/ActiveOrganizationINDV2054BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-12T00:00:002012-08-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationINDV2058STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDelays (Claims Handling)YesInformation Furnished; Claim Settled2012-07-13T00:00:002012-10-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING2059SAFECO LLOYDS INSURANCE COMPANYInsuredPremium and RatingNoCompany Position Upheld; Information Furnished2012-07-13T00:00:002012-10-19T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent3223Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN2060ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferYesInformation Furnished2012-07-13T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDVDIMINISHED VALUE; GR-Claim Evaluation; REPLACEMENT VEHICLE2062INFINITY COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld2012-07-13T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass1197Ins Co - Licensed/ActiveOrganizationINDV2066STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredLiability DisputeNoInformation Furnished2012-07-13T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV2067REASSURE AMERICA LIFE INSURANCE COMPANYRelativeCash Value; Delays (Policyholder Service)NoContract Language/Legal Issue; Information Furnished2012-07-12T00:00:002012-09-27T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured1228Ins Co - Licensed/ActiveOrganizationINDV2073GERMANIA FARM MUTUAL INSURANCE ASSOCIATIONConsumer (Non-Insured)Unsatisfactory Settle/OfferNoCompany Position Upheld2012-07-13T00:00:002012-10-27T00:00:00Property and CasualtyHomeownersHomeownersInsured2468Ins Co - Licensed/ActiveOrganizationINDVOVERHEAD AND PROFIT2077ASI LLOYDSInsuredDelays (Claims Handling)NoContract Language/Legal Issue; Information Furnished2012-07-13T00:00:002012-08-28T00:00:00Property and CasualtyHomeownersHomeowners14728Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DEDUCTIBLE2079GERMANIA INSURANCE COMPANYInsuredCancellationNoCompany Position Upheld2012-07-13T00:00:002012-09-10T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company1159Ins Co - Licensed/ActiveOrganizationINDV2080OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Payment Expected; Information Furnished2012-07-13T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private PassCorrespondent Person; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING2082COMPANION PROPERTY AND CASUALTY INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld; Contract Language/Legal Issue2012-07-13T00:00:002012-10-27T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person10484Ins Co - Licensed/ActiveOrganizationINDVROOF; WATER DAMAGE2084OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished2012-07-13T00:00:002013-02-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2085AETNA LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-11T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG2087STANDARD FIRE INSURANCE COMPANY, THEInsuredRefund Of PremiumNoCompany Position Upheld; Information Furnished2012-07-13T00:00:002012-10-19T00:00:00Property and CasualtyHomeownersHomeowners1493Ins Co - Licensed/ActiveOrganizationINDV2088SAFECO INSURANCE COMPANY OF INDIANAInsuredDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-07-13T00:00:002012-10-10T00:00:00Property and CasualtyHomeownersHomeowners2496Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2089BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-07-06T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGGRANDFATHERED HEALTH PLAN2090NATIONWIDE PROPERTY AND CASUALTY INSURANCE COMPANYInsuredRefund Of PremiumNoCompany Position Upheld2012-07-13T00:00:002012-09-06T00:00:00Property and CasualtyHomeownersHomeowners3165Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN2091BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONRelativeUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-09T00:00:002012-08-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV2092AMICA MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Denial Of ClaimNoCompany Position Upheld; Question of Fact2012-07-13T00:00:002012-08-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass3532Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; EXAM UNDER OATH; GR-Claim Evaluation2092Danek, Brian JasonInsuredOtherNoReferred for Disciplinary Actn2012-07-13T00:00:002012-08-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass1132612OtherIndividualINDVADJUSTER'S HANDLING; EXAM UNDER OATH; GR-Claim Evaluation2094STATE FARM LLOYDSInsuredCust Service Claim Handling; Delays (Claims Handling)NoAdditional Payment Expected; Information Furnished2012-07-13T00:00:002012-10-15T00:00:00Property and CasualtyHomeownersRental3105Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE2095OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyCust Service Claim HandlingYesCorrective Action Taken2012-07-13T00:00:002012-10-18T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Company1823Ins Co - Licensed/ActiveOrganizationINDV2096PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoAdditional Monies Received; Information Furnished2012-07-13T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person1708Ins Co - Licensed/ActiveOrganizationINDV2097OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)YesInformation Furnished2012-07-13T00:00:002012-10-10T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2098UNITEDHEALTHCARE INSURANCE COMPANYRelativePremium NoticeNoNo Jurisdiction2012-07-09T00:00:002012-08-21T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1348Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN2100SOUTHERN COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)YesInformation Furnished; Claim Settled2012-07-13T00:00:002012-10-05T00:00:00Property and CasualtyAutomobileMobile OwnersAssociated Subject Agency; Insured1583Ins Co - Licensed/ActiveOrganizationINDV2102FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoClaim Settled2012-07-13T00:00:002012-09-05T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent2623Ins Co - Licensed/ActiveOrganizationINDV2103MERCURY SELECT MANAGEMENT COMPANYConsumer (Non-Insured)Not Within TDI JurisdictionNoReferred To2012-07-17T00:00:002012-08-03T00:00:00Property and CasualtyMiscellaneousWarranty Contract25387OtherOrganizationINDV2104PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)YesAdditional Payment Expected; Information Furnished2012-07-13T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1708Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2106PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Additional Payment Expected; Additional Monies Received2012-07-13T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1708Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING2107DRIVER'S INSURANCE COMPANYLienholderDelays (Claims Handling); Denial Of ClaimNoInformation Furnished2012-07-13T00:00:002012-10-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass2038Ins Co - Licensed/ActiveOrganizationINDV2108METROPOLITAN LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoRecord Only2012-07-09T00:00:002012-08-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured13191Ins Co - Licensed/ActiveOrganizationORG2109PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Question of Fact2012-07-13T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1708Ins Co - Licensed/ActiveOrganizationINDV2110NATIONAL GENERAL INSURANCE COMPANYInsuredPremium NoticeYesPremium Refunded2012-07-13T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass1953Ins Co - Licensed/ActiveOrganizationINDV2114PHL VARIABLE INSURANCE COMPANYAttorneyMisrepresentationNoContract Language/Legal Issue; Question of Fact2012-07-06T00:00:002012-10-16T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesInsured612Ins Co - Licensed/ActiveOrganizationINDV2116ACE AMERICAN INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled; Information Furnished; Additional Monies Received2012-07-16T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured Company2327Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; LOSS OF USE2117AETNA LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue; Additional Monies Received2012-07-06T00:00:002012-08-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDVEXPERIMENTAL/INVESTIGATIONAL2118NATIONAL GENERAL ASSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished; Company Position Upheld2012-07-14T00:00:002012-09-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass7765Ins Co - Licensed/ActiveOrganizationINDVACV; UNDERWRITING CRITERIA2122BANKERS LIFE AND CASUALTY COMPANYConsumer (Non-Insured)Other; Premium NoticeYesInformation Furnished2012-07-12T00:00:002012-09-17T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life3030Ins Co - Licensed/ActiveOrganizationINDV2125SOUTHERN FARM BUREAU LIFE INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished2012-07-09T00:00:002012-09-11T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1523Ins Co - Licensed/ActiveOrganizationINDV2126OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYAttorneyUnsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received2012-07-09T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured1823Ins Co - Licensed/ActiveOrganizationINDV2128BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimYesAdditional Monies Received2012-07-09T00:00:002012-10-14T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationINDV2129UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-09T00:00:002012-08-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG2130JEFFERSON NATIONAL LIFE INSURANCE COMPANYRelativeCust Service Claim HandlingNoInformation Furnished2012-07-09T00:00:002012-08-10T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person; Third Party Admin-Non Licensed2439Ins Co - Licensed/ActiveOrganizationINDV2131AETNA LIFE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-09T00:00:002012-08-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV2132AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-09T00:00:002012-08-08T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG2133GUARDIAN LIFE INSURANCE COMPANY OF AMERICA, THEProviderUnsatisfactory Settle/OfferNoAdditional Monies Received; Information Furnished2012-07-09T00:00:002012-09-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2414Ins Co - Licensed/ActiveOrganizationINDV2134AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-09T00:00:002012-08-08T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG2135AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoAdditional Monies Received; Information Furnished; No Jurisdiction2012-07-09T00:00:002012-08-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured245Ins Co - Licensed/ActiveOrganizationORG2136AMERICAN NATIONAL INSURANCE COMPANYInsuredDelays (Underwriting)YesInformation Furnished2012-07-09T00:00:002012-08-22T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life135Ins Co - Licensed/ActiveOrganizationINDV2137UNITED CONCORDIA INSURANCE COMPANYProviderDenial Of ClaimNoContract Language/Legal Issue2012-07-09T00:00:002012-08-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured3624Ins Co - Licensed/ActiveOrganizationINDV2139UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-10T00:00:002012-08-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGBUNDLING2140AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-10T00:00:002012-08-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG2141BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-07-10T00:00:002012-09-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGBUNDLING2142GENWORTH LIFE INSURANCE COMPANYRelativeDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-07-10T00:00:002012-10-05T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured; Third Party Admin-Licensed1309Ins Co - Licensed/ActiveOrganizationINDV2143UNITEDHEALTHCARE INSURANCE COMPANYPhysicianNot Within TDI JurisdictionNoNo Jurisdiction2012-07-10T00:00:002012-08-28T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured Company1348Ins Co - Licensed/ActiveOrganizationORG2144BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/Offer; Usual And CustomaryNoInformation Furnished; No Jurisdiction2012-07-10T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGBUNDLING2145BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/Offer; Usual And CustomaryNoInformation Furnished2012-07-10T00:00:002012-08-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2146BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUsual And CustomaryYesNo Jurisdiction2012-07-10T00:00:002012-09-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2147BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-07-10T00:00:002012-08-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2148BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUsual And CustomaryNoNo Jurisdiction2012-07-10T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2149BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUsual And CustomaryNoCompany Position Upheld; No Jurisdiction; Information Furnished2012-07-10T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2150BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUsual And CustomaryNoNo Jurisdiction; Information Furnished2012-07-10T00:00:002013-01-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2151BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/Offer; Usual And CustomaryNoInformation Furnished; Contract Language/Legal Issue2012-07-10T00:00:002012-09-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2152BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/Offer; Usual And CustomaryNoCompany Position Upheld; Information Furnished2012-07-10T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2157BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/Offer; Usual And CustomaryNoNo Jurisdiction; Information Furnished2012-07-10T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2158LIBERTY LIFE ASSURANCE COMPANY OF BOSTONInsuredDelays (Claims Handling); Denial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-07-18T00:00:002012-08-21T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2205Ins Co - Licensed/ActiveOrganizationINDV2159COLONIAL COUNTY MUTUAL INSURANCE COMPANYThird PartyUnfair Discrim-Clms HandlingNoCompany Position Upheld2012-07-13T00:00:002012-09-05T00:00:00Property and CasualtyAutomobileIndividual Private Pass2455Ins Co - Licensed/ActiveOrganizationINDV2161FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and Rating; Refund Of PremiumNoPremium Refunded2012-07-13T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDV2164HALLMARK INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoAdditional Payment Expected; Information Furnished2012-07-12T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass24193Ins Co - Licensed/ActiveOrganizationINDV2166ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoClaim Settled; Information Furnished; Additional Monies Received2012-07-11T00:00:002012-09-17T00:00:00Property and CasualtyHomeownersHomeowners936Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; DAMAGE DISPUTE; ROOF2168FARMERS INSURANCE EXCHANGEThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue; Company Position Upheld2012-07-13T00:00:002012-08-28T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured Company2668Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF; COMPARATIVE NEGLIGENCE; DAMAGE DISPUTE; GR-Claim Evaluation2169ALLSTATE INSURANCE COMPANYConsumer (Non-Insured)Use of Credit ReportsNoInformation Furnished2012-07-12T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private Pass168Ins Co - Licensed/ActiveOrganizationINDVCREDIT REPORT2170NATIONAL LLOYDS INSURANCE COMPANYConsumer (Non-Insured)Delays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished2012-07-10T00:00:002012-10-22T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person; Insured1914Ins Co - Licensed/ActiveOrganizationORG2171MUTUAL OF OMAHA INSURANCE COMPANYInsuredRefund Of PremiumYesInformation Furnished; Premium Refunded2012-07-12T00:00:002012-09-13T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1977Ins Co - Licensed/ActiveOrganizationINDV2172STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeNoComplainant Retained Attorney; Information Furnished2012-07-12T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2173GEOVERA SPECIALTY INSURANCE COMPANYInsuredPremium and RatingNoCompany Position Upheld; Information Furnished2012-07-12T00:00:002012-10-19T00:00:00Property and CasualtyHomeownersHomeownersInsured56985Ins Co - Surplus LinesOrganizationINDV2174DRIVER'S INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-07-12T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency2038Ins Co - Licensed/ActiveOrganizationINDVACV; DAMAGE DISPUTE; GR-Claim Evaluation; TOTAL LOSS2175ALLSTATE TEXAS LLOYD'SRelativeCust Service Claim HandlingNoCompany Position Upheld2012-05-03T00:00:002012-09-21T00:00:00Property and CasualtyHomeownersHomeowners3721Ins Co - Licensed/ActiveOrganizationINDVDEPRECIATION; GR-Claim Evaluation; LOSS OF USE; SENIOR CITIZEN; UNCOOPERATIVE INSURED2175JANSEN INTERNATIONAL, LLCRelativeCust Service Claim Handling; Delays (Claims Handling)NoCompany Position Upheld; Information Furnished2012-05-03T00:00:002012-09-21T00:00:00Property and CasualtyHomeownersHomeowners25081Public Insurance AdjusterOrganizationINDVDEPRECIATION; GR-Claim Evaluation; LOSS OF USE; SENIOR CITIZEN; UNCOOPERATIVE INSURED2178TEXAS FARMERS INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld; Information Furnished2012-07-12T00:00:002012-09-11T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; HAIL; MOLD; ROOF; WATER DAMAGE2179HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Denial Of ClaimNoContract Language/Legal Issue2012-07-17T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency2362Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2180ASI LLOYDSInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld; Additional Monies Received; Information Furnished2012-07-17T00:00:002012-10-16T00:00:00Property and CasualtyHomeownersHomeowners14728Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; SUPPLEMENTARY PAYMENT; WATER DAMAGE2181HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld; Additional Payment Expected; Information Furnished2012-07-17T00:00:002012-10-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass2362Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2181Freeway Insurance AgencyInsuredAgent HandlingNoAdditional Monies Received2012-07-17T00:00:002012-10-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass67264AgentOrganizationINDVGR-Claim Evaluation2182MATTHEWS INSURANCE GROUP INCInsuredAgent Handling; Refund Of PremiumNoInformation Furnished; Premium Refunded2012-07-17T00:00:002012-09-26T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company21524AgentOrganizationINDVUNCOOPERATIVE INSURED2182UNIVERSAL NORTH AMERICA INSURANCE COMPANYInsuredRefund Of PremiumNoAdditional Monies Received2012-07-17T00:00:002012-09-26T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company23526Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED2183GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredCust Service Claim HandlingNoClaim Settled; Information Furnished2012-07-17T00:00:002012-10-01T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING2185PRUDENTIAL INSURANCE COMPANY OF AMERICA, THEInsuredDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-07-17T00:00:002012-09-21T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured1729Ins Co - Licensed/ActiveOrganizationINDV2186PROGRESSIVE ADVANCED INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-07-17T00:00:002012-10-12T00:00:00Property and CasualtyMiscellaneousWatercraft19817Ins Co - Licensed/ActiveOrganizationINDV2187WESTERN SURETY COMPANYAttorneyDelays (Claims Handling)NoClaim Settled; Information Furnished; Additional Monies Received2012-07-17T00:00:002012-10-30T00:00:00Property and CasualtyMiscellaneousFidelity & Surety1163Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING2188ESURANCE INSURANCE COMPANYInsuredLiability DisputeNoQuestion of Fact; Information Furnished2012-07-17T00:00:002012-11-29T00:00:00Property and CasualtyAutomobileIndividual Private Pass1350Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2190ALLSTATE TEXAS LLOYD'SInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished; Question of Fact2012-07-17T00:00:002012-09-28T00:00:00Property and CasualtyHomeownersHomeowners3721Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; HAIL; OVERHEAD AND PROFIT; ROOF2191BANKERS LIFE AND CASUALTY COMPANYInsuredPremium NoticeNoInformation Furnished; Contract Language/Legal Issue2012-07-10T00:00:002012-10-10T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life3030Ins Co - Licensed/ActiveOrganizationINDV2192LOYA INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimYesClaim Settled; Information Furnished2012-07-17T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured15643Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE2193TEXAS FARM BUREAU CASUALTY INSURANCE COMPANYInsuredLiability DisputeNoQuestion of Fact; Information Furnished2012-07-17T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass28440Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2194OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYConsumer (Non-Insured)Denial Of ClaimNoInformation Furnished; Company Position Upheld2012-07-17T00:00:002012-09-20T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF; UNCOOPERATIVE INSURED; UNDERWRITING CRITERIA2195UNION FIDELITY LIFE INSURANCE COMPANYRelativeOtherNoInformation Furnished2012-07-11T00:00:002012-09-24T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured2783Ins Co - Licensed/ActiveOrganizationINDV2197FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeNoQuestion of Fact; Information Furnished2012-07-13T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2623Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation; MULTIPLE INSUREDS2198ELEPHANT INSURANCE COMPANYInsuredRefund Of PremiumYesInformation Furnished; Premium Refunded2012-07-13T00:00:002012-08-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass52783Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA2199NATIONAL PACIFIC DENTAL, INC.InsuredDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-07-11T00:00:002012-09-18T00:00:00Health Maintenance OrgAccident and HealthGroup A&H3669Health Maintenance OrgOrganizationINDV2200GENERAL INSURANCE COMPANY OF AMERICAThird PartyUnsatisfactory Settle/OfferYesAdditional Monies Received; Information Furnished2012-07-17T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured2508Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; LOSS OF USE2201FAMILY LIFE INSURANCE COMPANYInsuredPremium NoticeNoInformation Furnished2012-07-11T00:00:002012-11-14T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2657Ins Co - Licensed/ActiveOrganizationINDV2204FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Liability DisputeYesClaim Settled; Information Furnished2012-07-17T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2623Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation2205STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyOtherNoInformation Furnished2012-07-17T00:00:002012-09-18T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING2205METROPOLITAN LLOYDS INSURANCE COMPANY OF TEXASThird PartyDelays (Claims Handling)NoClaim Settled; Additional Monies Received2012-07-17T00:00:002012-09-18T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured3848Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING2207ATLANTIC CASUALTY INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; Information Furnished; Question of Fact2012-07-17T00:00:002012-10-29T00:00:00Property and CasualtyLiabilityGeneral LiabilityAssociated Agent; Associated Subject Agency52002Ins Co - Licensed/ActiveOrganizationORG2208STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-07-17T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; EMERGENCY CARE; GR-Claim Evaluation2209UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.PhysicianDenial Of ClaimNoInformation Furnished; No Jurisdiction2012-07-11T00:00:002012-10-10T00:00:00Medicare HMOAccident and HealthGroup A&HInsured14666Health Maintenance OrgOrganizationINDVMULTIPLE INSUREDS2210ALLSTATE TEXAS LLOYD'SInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-07-18T00:00:002012-10-12T00:00:00Property and CasualtyHomeownersHomeowners3721Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; TOTAL LOSS; WILDFIRES 20112211AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-11T00:00:002012-08-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG2212STATE FARM LLOYDSOtherUnsatisfactory Settle/OfferYesInformation Furnished; Contract Language/Legal Issue2012-07-17T00:00:002012-09-28T00:00:00Property and CasualtyHomeownersHomeownersInsured3105Ins Co - Licensed/ActiveOrganizationORGHAIL; ROOF; SENIOR CITIZEN2213STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Question of Fact2012-07-02T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV2214STATE AUTO PROPERTY & CASUALTY INSURANCE COMPANYInsuredDelays (Claims Handling)YesClaim Settled; Additional Monies Received2012-07-17T00:00:002012-09-28T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person28439Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; HAIL; ROOF; SUPPLEMENTARY PAYMENT; WATER DAMAGE2215AMERICAN RISK INSURANCE COMPANY, INC.InsuredCust Service Claim Handling; Delays (Claims Handling)YesInformation Furnished2012-07-17T00:00:002012-10-19T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person27377Ins Co - Licensed/ActiveOrganizationINDV2217FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Contract Language/Legal Issue2012-07-02T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured2623Ins Co - Licensed/ActiveOrganizationINDV2218DRIVER'S INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-07-02T00:00:002012-09-18T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency2038Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF2219QBE SPECIALTY INSURANCE COMPANYThird PartyPremium and RatingNoInformation Furnished2012-07-02T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company49803Ins Co - Licensed/ActiveOrganizationINDV2221ELEPHANT INSURANCE COMPANYInsuredOtherNoPremium Refunded2012-07-13T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private Pass52783Ins Co - Licensed/ActiveOrganizationINDV2222PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferYesInformation Furnished; Additional Monies Received2012-07-02T00:00:002012-09-24T00:00:00Property and CasualtyAutomobileIndividual Private PassCorrespondent Person1708Ins Co - Licensed/ActiveOrganizationINDV2223AMICA LLOYD'S OF TEXASThird PartyNon-Disclosure Of CoverageNoInformation Furnished2012-07-02T00:00:002012-10-12T00:00:00Property and CasualtyHomeownersHomeownersInsured9172Ins Co - Licensed/ActiveOrganizationINDV2225AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-11T00:00:002012-11-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Self-Funded / ErisaOrganizationORG2226CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Contract Language/Legal Issue; Information Furnished2012-07-11T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORGBUNDLING; MULTIPLE INSUREDS2227HUMANA HEALTH PLAN OF TEXAS, INC.ProviderCust Service Claim Handling; Unsatisfactory Settle/Offer; XX-RecoupmentNoNo Jurisdiction; Contract Language/Legal Issue; Information Furnished2012-06-05T00:00:002012-08-29T00:00:00Medicare HMOAccident and HealthGroup A&HCorrespondent Person; Insured702Health Maintenance OrgOrganizationORG2228UNITEDHEALTHCARE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-12T00:00:002012-08-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Associated Subject Person1348Ins Co - Licensed/ActiveOrganizationINDV2229OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Claim Settled2012-07-02T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1823Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2230AETNA LIFE INSURANCE COMPANYInsuredDenial Of Claim; OtherNoInformation Furnished; Other2012-07-12T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person245Ins Co - Licensed/ActiveOrganizationINDV2233BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-07-13T00:00:002012-10-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV2234TIME INSURANCE COMPANYInsuredMisrepresentationNoContract Language/Legal Issue2012-07-12T00:00:002012-09-18T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company1374Ins Co - Licensed/ActiveOrganizationINDVRESCISSION2234PIERRON, CHRISTOPHER TODDInsuredMisrepresentationNoQuestion of Fact2012-07-12T00:00:002012-09-18T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company857283AgentIndividualINDVRESCISSION2235AETNA LIFE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished; No Jurisdiction2012-07-12T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV2237AETNA HEALTH INC.ProviderUnsatisfactory Settle/OfferYesAdditional Monies Received; Information Furnished2012-07-12T00:00:002012-09-18T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured3522Health Maintenance OrgOrganizationINDV2238OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Claim Settled2012-07-17T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING2240WILLIAMS, STEVE BInsurance CompanyAgency BalanceYesOther2012-07-09T00:00:002012-08-10T00:00:00Life, Accident and HealthAccident and HealthXX-State Specific808292AgentIndividualORG2241ANDRADE, RICHARD RInsurance CompanyAgency BalanceNoOther2012-07-09T00:00:002012-08-17T00:00:00Life, Accident and HealthAccident and HealthXX-State Specific1087502AgentIndividualORG2242DE HOYOS, ROLAND ERNESTInsurance CompanyAgency BalanceYesOther2012-07-11T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H537599AgentIndividualORG2243CRYAN, KERRI LInsurance CompanyAgency BalanceYesOther2012-07-11T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthXX-State Specific498751AgentIndividualORG2244WILHITE, MATTHEW CHRISTOPHERInsurance CompanyAgency BalanceYesOther2012-07-11T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthXX-State Specific1102676AgentIndividualORG2246FLORES, MARY LInsurance CompanyAgency BalanceYesOther2012-07-11T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthXX-State Specific969275AgentIndividualORG2247CAVAZOS, MICHAEL DAVIDInsurance CompanyAgency BalanceYesOther2012-07-11T00:00:002012-09-10T00:00:00Life, Accident and HealthAccident and HealthXX-State Specific941065AgentIndividualORG2248STEVENS, ROBERT ALLENInsurance CompanyAgency BalanceYesOther2012-07-09T00:00:002012-09-14T00:00:00Life, Accident and HealthAccident and HealthXX-State Specific295108AgentIndividualORG2249FOWLER, PHILLIP WAYLANDInsurance CompanyAgency BalanceYesOther2012-07-09T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthXX-State Specific801284AgentIndividualORG2250HUMANA HEALTH PLAN OF TEXAS, INC.ProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Additional Payment Expected2012-07-12T00:00:002012-08-27T00:00:00Medicare HMOAccident and HealthIndividual A & HInsured702Health Maintenance OrgOrganizationINDVSENIOR CITIZEN2252THORNBURG, LINDA SUEInsurance CompanyAgency BalanceNoOther2012-07-09T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthXX-State Specific809716AgentIndividualORG2253GIBSON, LEONARD ALLEN JRInsurance CompanyAgency BalanceYesOther2012-07-11T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthXX-State Specific981516AgentIndividualORG2254RODRIGUEZ, DANIEL EDUARDO JRInsurance CompanyAgency BalanceYesOther2012-07-09T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthXX-State Specific846177AgentIndividualORG2255GONZALEZ, ROSA MARGARITAInsurance CompanyAgency BalanceYesOther2012-07-11T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthXX-State Specific1093860AgentIndividualORG2256TREVINO, MARTHA LETICIAInsurance CompanyAgency BalanceYesOther2012-07-11T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthXX-State Specific290583AgentIndividualORG2258CONNECTICUT GENERAL LIFE INSURANCE COMPANYRelativeDenial Of ClaimNoNo Jurisdiction2012-07-18T00:00:002012-09-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&HGR Elected Official; Insured2851Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2259CHATMON, ORETTA MARILYNInsurance CompanyAgency BalanceYesOther2012-07-09T00:00:002012-09-14T00:00:00Life, Accident and HealthAccident and HealthXX-State Specific353567AgentIndividualORG2260MEDINA, LAURA MInsurance CompanyAgency BalanceYesOther2012-07-11T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthXX-State Specific962242AgentIndividualORG2261TAVARES, CAROLINAInsurance CompanyAgency BalanceYesOther2012-07-11T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthXX-State Specific829711AgentIndividualORG2263DUMAS YOUNG, DIANNEInsurance CompanyAgency BalanceYesOther2012-07-11T00:00:002012-08-09T00:00:00Life, Accident and HealthAccident and HealthXX-State Specific848621AgentIndividualORG2264JONES, GISELAInsurance CompanyAgency BalanceYesOther2012-07-09T00:00:002012-08-10T00:00:00Life, Accident and HealthAccident and HealthXX-State Specific464926AgentIndividualORG2265STOKES, AMBER NICOLEInsurance CompanyAgency BalanceYesOther2012-07-03T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthXX-State Specific943961AgentIndividualORG2266SMITH, REYNA YOLANDAInsurance CompanyAgency BalanceYesOther2012-07-09T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthXX-State Specific651941AgentIndividualORG2267SERRATO, LAURA ELENAInsurance CompanyAgency BalanceYesOther2012-07-11T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthXX-State Specific893823AgentIndividualORG2269PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)NoInformation Furnished; Claim Settled2012-07-16T00:00:002012-10-05T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDV2272AETNA LIFE INSURANCE COMPANYConsumer (Non-Insured)Refusal to InsureNoContract Language/Legal Issue2012-07-13T00:00:002012-09-24T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H245Ins Co - Licensed/ActiveOrganizationINDV2278BENEFITS AMERICA NA INCConsumer (Non-Insured)OtherYesOpened/Linked to Case File; Contract Language/Legal Issue; Referred for Disciplinary Actn2012-07-12T00:00:002012-09-24T00:00:00Life, Accident and HealthAccident and HealthDiscount Health Care ProgramAssociated Subject Company67324OtherOrganizationORG2287Williams, JuliaConsumer (Non-Insured)OtherNoInsufficient Information2012-07-13T00:00:002012-09-19T00:00:00Life, Accident and HealthMiscellaneousNo Line Specified1133489OtherIndividualINDV2295HARTFORD LIFE AND ACCIDENT INSURANCE COMPANYBeneficiaryUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-07-12T00:00:002012-08-31T00:00:00Life, Accident and HealthLife & AnnuityGroup LifeDeceased Person2383Ins Co - Licensed/ActiveOrganizationINDV2298FETCH INSURANCE SRVICES, LLC.Insurance CompanyOtherYesReferred To2012-07-18T00:00:002012-09-19T00:00:00Life, Accident and HealthMiscellaneousP & C MiscAssociated Subject Agency; Associated Subject Company27650AgentOrganizationORGADVERTISING2299FAMILY HERITAGE LIFE INSURANCE COMPANY OF AMERICAInsuredDelays (Policyholder Service)NoPremium Refunded; Information Furnished2012-07-13T00:00:002012-08-20T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life3535Ins Co - Licensed/ActiveOrganizationINDV2303Healthcare AllianceConsumer (Non-Insured)OtherNoRecord Only2012-07-13T00:00:002012-08-09T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life66875No Entity Complained AgainstOrganizationINDV2306TRANS WORLD ASSURANCE COMPANYMilitary PersonnelMisrepresentationNoQuestion of Fact2012-07-13T00:00:002012-11-07T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1386Ins Co - Licensed/ActiveOrganizationINDV2306HOLGUIN, JOHN PATRICKMilitary PersonnelMisrepresentationNoQuestion of Fact2012-07-13T00:00:002012-11-07T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life983974AgentIndividualINDV2307UNITEDHEALTHCARE INSURANCE COMPANYNon-Contracted ProviderRecoupment Of Claims PaymentYesAdditional Monies Received; Claim Settled2012-07-13T00:00:002013-06-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured1348Ins Co - Licensed/ActiveOrganizationORG2308UNITEDHEALTHCARE INSURANCE COMPANYInsuredDenial Of ClaimYesClaim Settled2012-07-13T00:00:002012-09-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE2309GROUP & PENSION ADMINISTRATORS, INC.InsuredDenial Of ClaimNoNo Jurisdiction2012-07-13T00:00:002012-09-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured32390Third Party AdministratorsOrganizationINDV2310UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-07-13T00:00:002012-08-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV2311AMERICAN NATIONAL PROPERTY AND CASUALTY COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-07-16T00:00:002012-09-13T00:00:00Property and CasualtyMiscellaneousP & C MiscAssociated Subject Agency80Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; TOTAL LOSS2312TIME INSURANCE COMPANYInsuredDenial Of ClaimYesClaim Settled; Additional Monies Received; Corrective Action Taken2012-07-13T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company1374Ins Co - Licensed/ActiveOrganizationINDV231321ST CENTURY CENTENNIAL INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished2012-07-16T00:00:002012-09-17T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured771Ins Co - Licensed/ActiveOrganizationINDV2315HARTFORD LLOYD'S INSURANCE COMPANYInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferYesInformation Furnished; Contract Language/Legal Issue2012-07-16T00:00:002012-10-05T00:00:00Property and CasualtyFire, Allied Lines & CMPBusiness OwnersAssociated Agent; Third Party Admin-Licensed1017Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING2316UNITRIN PREFERRED INSURANCE COMPANYInsuredPremium and RatingNoCompany Position Upheld2012-07-16T00:00:002012-10-22T00:00:00Property and CasualtyHomeownersHomeowners1261Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA2316VAN MATRE, JEFFERY SCOTTInsuredPremium and RatingNoInformation Furnished2012-07-16T00:00:002012-10-22T00:00:00Property and CasualtyHomeownersHomeowners237154AgentIndividualINDVUNDERWRITING CRITERIA2317KEY BENEFIT ADMINISTRATORS, INC.InsuredOtherNoCancellation Withdrawn2012-07-13T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&H191581Third Party AdministratorsOrganizationINDVCOVERAGE DISPUTE2318SAN ANTONIO INDEMNITY COMPANYInsuredDenial Of ClaimNoClaim Settled; Additional Monies Received2012-07-16T00:00:002012-10-04T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company975Ins Co - Licensed/ActiveOrganizationINDVHAIL; ROOF; UNDERWRITING CRITERIA2318KINNARD INSURANCE AGENCY INC.InsuredConversion; Unauthorized ActsYesReferred for Disciplinary Actn2012-07-16T00:00:002012-10-04T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company25021Insurance AgencyOrganizationINDVHAIL; ROOF; UNDERWRITING CRITERIA2319PHOENIX LIFE INSURANCE COMPANYThird PartyMisrepresentationYesReferred for Disciplinary Actn2012-07-13T00:00:002012-09-10T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesAssociated Subject Company1785Ins Co - Licensed/ActiveOrganizationINDVVIATICAL SETTLEMENT2319CONSOLIDATED WEALTH MANAGEMENT LLCThird PartyMisrepresentationYesReferred for Disciplinary Actn2012-07-13T00:00:002012-09-10T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesAssociated Subject Company67342Insurance AgencyOrganizationINDVVIATICAL SETTLEMENT2319OSBORNE, SCOTT ALLENThird PartyMisrepresentationYesReferred for Disciplinary Actn2012-07-13T00:00:002012-09-10T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesAssociated Subject Company332898AgentIndividualINDVVIATICAL SETTLEMENT2319CERVENKA, BRIAN RAYThird PartyMisrepresentationYesReferred for Disciplinary Actn2012-07-13T00:00:002012-09-10T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesAssociated Subject Company432044AgentIndividualINDVVIATICAL SETTLEMENT2321TEXAS HEALTHSPRING, LLCProviderDelays (Claims Handling)NoInformation Furnished2012-07-13T00:00:002012-08-22T00:00:00Medicare Managed Care for HMOAccident and HealthIndividual A & H18634Health Maintenance OrgOrganizationORG2322LIFE INSURANCE COMPANY OF NORTH AMERICAInsuredDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-07-13T00:00:002012-11-27T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2157Ins Co - Licensed/ActiveOrganizationINDV2324JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.)InsuredPremium NoticeNoContract Language/Legal Issue; Information Furnished2012-07-13T00:00:002012-08-20T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1148Ins Co - Licensed/ActiveOrganizationINDV2325ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredDelays (Policyholder Service)NoInformation Furnished2012-07-20T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDV2325BROWN, MONROE JAMES IIIInsuredDelays (Policyholder Service)NoInformation Furnished2012-07-20T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass26158AgentIndividualINDV2326FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)NoClaim Settled; Information Furnished2012-07-16T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2623Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING2327RIVERSOURCE LIFE INSURANCE COMPANYInsuredMisrepresentationNoInformation Furnished; Contract Language/Legal Issue2012-07-13T00:00:002012-09-21T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities2321Ins Co - Licensed/ActiveOrganizationINDV2327VASSO, NEAL DOUGLASInsuredMisrepresentationNoInformation Furnished; Question of Fact2012-07-13T00:00:002012-09-21T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities242377AgentIndividualINDV2329AMERICAN GENERAL LIFE INSURANCE COMPANYRelativeMisrepresentationNoContract Language/Legal Issue; Information Furnished2012-07-13T00:00:002012-08-27T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life152Ins Co - Licensed/ActiveOrganizationINDV2330UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoContract Language/Legal Issue; Information Furnished2012-07-13T00:00:002012-08-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGBUNDLING2331STATE FARM LLOYDSInsuredEndorsement / RiderNoInformation Furnished2012-05-24T00:00:002012-08-22T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVFOUNDATION 2331MIMS, GARY DOUGLASInsuredAgent HandlingNoQuestion of Fact2012-05-24T00:00:002012-08-22T00:00:00Property and CasualtyHomeownersHomeowners55571AgentIndividualINDVFOUNDATION 2332UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoAdditional Monies Received; Claim Settled2012-07-13T00:00:002012-08-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG2335ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferNoClaim Settled; Information Furnished2012-07-16T00:00:002012-09-18T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured936Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; LOSS OF USE; TOTAL LOSS2337CUNNINGHAM INSURANCE AGENCY INCInsuredRefund Of PremiumNoInformation Furnished2012-07-16T00:00:002012-10-15T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied LinesAssociated Agent9812AgentOrganizationORGUNDERWRITING CRITERIA2337BLISS AND GLENNON, INC.InsuredRefund Of PremiumNoInformation Furnished; Company Position Upheld2012-07-16T00:00:002012-10-15T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied LinesAssociated Agent27630AgentOrganizationORGUNDERWRITING CRITERIA2338ALLSTATE COUNTY MUTUAL INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferYesInformation Furnished2012-07-16T00:00:002012-09-14T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured2228Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; AFTERMARKET PARTS; DAMAGE DISPUTE; GR-Claim Evaluation2339AMERICAN FAMILY LIFE ASSURANCE COMPANY OF COLUMBUSInsuredDenial Of ClaimNoContract Language/Legal Issue2012-07-16T00:00:002012-10-14T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2655Ins Co - Licensed/ActiveOrganizationINDV2340CHICAGO TITLE INSURANCE COMPANYInsuredOtherYesPolicy Issued/Restored2012-07-03T00:00:002012-08-13T00:00:00Property and CasualtyHomeownersHomeowners51988Ins Co - Licensed/ActiveOrganizationORG2341MANAGED DENTALGUARD, INC.InsuredUnsatisfactory Settle/OfferNoClaim Settled; Additional Monies Received2012-07-14T00:00:002012-09-18T00:00:00Health Maintenance OrgAccident and HealthGroup A&H10898Health Maintenance OrgOrganizationINDV2343GERMANIA FARM MUTUAL INSURANCE ASSOCIATIONInsuredDelays (Claims Handling); Denial Of ClaimNoInformation Furnished2012-07-19T00:00:002012-08-21T00:00:00Property and CasualtyHomeownersHomeowners2468Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; UNDERWRITING CRITERIA2344STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Claim Settled2012-07-17T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV2345ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICAAttorneyCash ValueYesCash Surrender Paid; Contract Language/Legal Issue2012-07-12T00:00:002012-10-10T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesAssociated Agent910Ins Co - Licensed/ActiveOrganizationINDV2346SCOTT AND WHITE HEALTH PLANRelativeDelays In AuthorizationNoNo Jurisdiction2012-06-27T00:00:002012-08-28T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company; Insured788Health Maintenance OrgOrganizationINDV2347RELIABLE LIFE INSURANCE COMPANY, THEInsuredCash ValueNoInformation Furnished2012-07-11T00:00:002012-08-20T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured1704Ins Co - Licensed/ActiveOrganizationINDV2349UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-07-13T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDVPRESCRIPTION2350HUMANA INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesInformation Furnished; Additional Monies Received2012-07-13T00:00:002012-08-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person; Insured1040Ins Co - Licensed/ActiveOrganizationORG2351CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderClaim Recoding/BundlingNoNo Jurisdiction; Information Furnished2012-07-13T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured2851Ins Co - Licensed/ActiveOrganizationINDV2352LIFE PARTNERS, INC.Third PartyMisrepresentationNoNo Jurisdiction2012-07-13T00:00:002012-11-20T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company; Associated Subject Person; Insured55889Viatical Settlement Com/BrokerOrganizationINDV2353AETNA LIFE INSURANCE COMPANYProviderDenial Of ClaimYesClaim Settled; Additional Monies Received2012-07-12T00:00:002012-10-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORGCOVERAGE DISPUTE; EMERGENCY CARE; GR-Claim Evaluation2354MONUMENTAL LIFE INSURANCE COMPANYInsuredDelays (Policyholder Service)NoContract Language/Legal Issue; Information Furnished2012-07-13T00:00:002012-08-23T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Agent2010Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN2355AETNA LIFE INSURANCE COMPANYInsuredDelays In AuthorizationNoCompany Position Upheld; Information Furnished2012-07-12T00:00:002012-09-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV2356GREAT-WEST LIFE & ANNUITY INSURANCE COMPANYProviderNot Within TDI JurisdictionNoNo Jurisdiction2012-07-12T00:00:002012-12-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured1696Ins Co - Licensed/ActiveOrganizationORG2356EASTMAN COMPANY, INC., THEProviderUnsatisfactory Settle/OfferNo2012-07-12T00:00:002012-12-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured6107OtherOrganizationORG2357CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANYInsuredMisrepresentationNoInformation Furnished2012-07-12T00:00:002012-08-22T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H25422Ins Co - Licensed/ActiveOrganizationINDV2357DANIELS, JOE DONALDInsuredMisrepresentationNo2012-07-12T00:00:002012-08-22T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H455630AgentIndividualINDV2358BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction2012-07-12T00:00:002012-09-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationINDV2359UNITEDHEALTHCARE INSURANCE COMPANYInsuredOtherNoOther2012-07-12T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1348Ins Co - Licensed/ActiveOrganizationINDV2360GOVERNMENT EMPLOYEES HEALTH ASSOCIATION, INC.InsuredDenial Of ClaimNoNo Jurisdiction2012-06-25T00:00:002012-08-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&H49857Ins Co - Licensed/ActiveOrganizationINDV2362METROPOLITAN LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-12T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&H13191Ins Co - Licensed/ActiveOrganizationINDV2363VALUEOPTIONS, INC.InsuredDenial Of ClaimNoNo Jurisdiction2012-07-12T00:00:002012-09-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured44252Ins Co - Licensed/ActiveOrganizationINDV2364AETNA LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction2012-07-12T00:00:002012-08-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company245Ins Co - Licensed/ActiveOrganizationINDV2365BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoContract Language/Legal Issue; Cancel/Non-Renewal Upheld2012-07-12T00:00:002012-10-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2367Preexisting Condition Insurance PlanProviderOtherNoNo Jurisdiction2012-07-12T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company; Insured67818Govermental EntityOrganizationORGFEDERAL HEALTH CARE REFORM2368AETNA LIFE INSURANCE COMPANYProviderDenial Of Claim; Unsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-07-12T00:00:002012-08-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person; Insured245Ins Co - Licensed/ActiveOrganizationORG2369CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Company Position Upheld2012-07-12T00:00:002012-08-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORG2370BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoClaim Settled2012-07-12T00:00:002012-08-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2371UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-07-12T00:00:002012-08-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGBUNDLING2372CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-12T00:00:002012-09-10T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured25422Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN2373UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-12T00:00:002012-09-06T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG2374LOYA INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling); Denial Of ClaimYesAdditional Monies Received; Contract Language/Legal Issue2012-03-06T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass15643Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2375MOLINA HEALTHCARE INSURANCE COMPANYOtherDelays (Claims Handling)NoNo Jurisdiction2012-04-08T00:00:002013-04-11T00:00:00Health Maintenance OrgAccident and HealthIndividual A & HInsured3555Health Maintenance OrgOrganizationORG2376SELECTCARE OF TEXAS, L.L.C.Contracted ProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-07-12T00:00:002012-08-30T00:00:00Medicare HMOAccident and HealthGroup A&HAssociated Subject Company; Associated Subject Person; Correspondent Person; Insured14275Health Maintenance OrgOrganizationORGSENIOR CITIZEN2377CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-17T00:00:002012-08-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORG2378UNITEDHEALTHCARE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-07-17T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDVBUNDLING2380ENTRUST, INC.InsuredDelays (Claims Handling)NoNo Jurisdiction2012-07-17T00:00:002012-08-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&H161306Third Party AdministratorsOrganizationINDV2381HUMANA INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-17T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Third Party AdministratorsOrganizationORG2382CAREMARK, L.L.C.ProviderNot Within TDI Jurisdiction; OtherYesInformation Furnished; Contract Language/Legal Issue; No Jurisdiction2012-07-17T00:00:002012-09-28T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HGR Elected Official; Insured56496Third Party AdministratorsOrganizationORG2383LIFE INSURANCE COMPANY OF NORTH AMERICAInsuredDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-07-17T00:00:002012-08-21T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2157Ins Co - Licensed/ActiveOrganizationINDV2384LPL FINANCIAL CORPORATIONAgentMisrepresentationNoQuestion of Fact; Contract Language/Legal Issue2012-07-17T00:00:002012-09-05T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities23409Ins Co - Licensed/ActiveOrganizationINDV2384DAVIS, BETHANY NICOLEAgentMisrepresentationNoQuestion of Fact; Contract Language/Legal Issue2012-07-17T00:00:002012-09-05T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities754586AgentIndividualINDV2385UNITEDHEALTHCARE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-07-17T00:00:002012-08-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV2386OBREGON, ROBERTAgentAgency BalanceNoNo Jurisdiction2012-07-02T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company399725AgentIndividualINDV2387BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDelays In AuthorizationNoNo Jurisdiction2012-07-13T00:00:002012-08-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV2388AETNA LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-16T00:00:002012-08-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG2389UNITEDHEALTHCARE INSURANCE COMPANYInsuredDependent CoverageNoNo Jurisdiction2012-07-23T00:00:002012-08-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Associated Subject Person; Insured1348Ins Co - Licensed/ActiveOrganizationINDV2390LIBERTY LIFE ASSURANCE COMPANY OF BOSTONInsuredDelays (Claims Handling)NoNo Jurisdiction2012-07-16T00:00:002012-11-20T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2205Ins Co - Licensed/ActiveOrganizationINDV2393BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoNo Jurisdiction2012-07-19T00:00:002012-08-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV2394VALUEOPTIONS OF TEXAS, INC.InsuredDelays (Claims Handling)NoNo Jurisdiction2012-07-16T00:00:002012-09-06T00:00:00Life, Accident and HealthAccident and HealthGroup A&H8867Ins Co - Licensed/ActiveOrganizationINDV2395Turk Delbert Financial PlanningConsumer (Non-Insured)MisrepresentationNoInsufficient Information2012-07-13T00:00:002012-08-09T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Agent67388OtherOrganizationINDV2396CONNECTICUT GENERAL LIFE INSURANCE COMPANYInsuredNot Within TDI JurisdictionNoNo Jurisdiction2012-07-16T00:00:002012-11-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Ins Co - Licensed/ActiveOrganizationINDV2396CIGNA HEALTHCARE OF TEXAS, INC.InsuredCOBRA; CancellationNo2012-07-16T00:00:002012-11-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&H8294Ins Co - Licensed/ActiveOrganizationINDV2397American Savings ClubRelativeMisrepresentationNoInsufficient Information2012-07-16T00:00:002012-08-28T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H67393OtherOrganizationINDV2398BEECH STREET CORPORATIONRelativeMisrepresentationNoInformation Furnished2012-07-16T00:00:002012-11-02T00:00:00Life, Accident and HealthAccident and HealthDiscount Health Care Program52558OtherOrganizationINDV2398Beech Street CorporationRelativeMisrepresentationNo2012-07-16T00:00:002012-11-02T00:00:00Life, Accident and HealthAccident and HealthDiscount Health Care Program67735OtherOrganizationINDV2399CONNECTICUT GENERAL LIFE INSURANCE COMPANYAgentCash Value; Delays (Policyholder Service)NoClaim Settled; Contract Language/Legal Issue; Information Furnished2012-07-16T00:00:002012-09-18T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company; Deceased Person2851Ins Co - Licensed/ActiveOrganizationINDV2400REASSURE AMERICA LIFE INSURANCE COMPANYConsumer (Non-Insured)Other; OtherYesInformation Furnished2012-07-13T00:00:002012-10-03T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesInsured1228Ins Co - Licensed/ActiveOrganizationINDV2401BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction2012-07-13T00:00:002012-08-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV2402AETNA LIFE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-23T00:00:002012-08-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HGR Elected Official; Insured245Ins Co - Licensed/ActiveOrganizationINDV2403BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-07-13T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationORG2406BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction2012-07-09T00:00:002012-09-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV2408METROPOLITAN LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoAdditional Monies Received2012-07-16T00:00:002012-09-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured13191Ins Co - Licensed/ActiveOrganizationORG2409ALLSTATE INDEMNITY COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished2012-07-16T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured167Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2410UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-13T00:00:002012-08-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG2412ACCC INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-07-16T00:00:002012-09-14T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency9825Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; HAIL; TOTAL LOSS2414ENTRUST, INC.InsuredDenial Of ClaimNoNo Jurisdiction2012-07-13T00:00:002012-08-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&H161306Third Party AdministratorsOrganizationINDV2415SPEARS, DAN WALLACE JRInsurance CompanyAgency BalanceYesInformation Furnished2012-07-12T00:00:002013-05-02T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Agent454779AgentIndividualORG2416LEXINGTON INSURANCE COMPANYInsuredDelays (Claims Handling)YesInformation Furnished; Claim Settled; Additional Monies Received2012-07-16T00:00:002012-09-27T00:00:00Property and CasualtyAutomobileBusiness Automobile48870Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING2417ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredCancellationYesCompany Position Upheld2012-07-16T00:00:002012-09-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDV2418DELTA DENTAL OF CALIFORNIAProviderUnsatisfactory Settle/OfferNoCorrective Action Taken; Additional Monies Received2012-07-13T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured44231Third Party AdministratorsOrganizationINDV2420ALLSTATE COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-07-16T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2228Ins Co - Licensed/ActiveOrganizationINDVACV; GR-Claim Evaluation; TOTAL LOSS2421PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-07-16T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1708Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation2422AMERICAN NATIONAL INSURANCE COMPANYInsuredOtherNoNo Jurisdiction2012-07-23T00:00:002012-10-18T00:00:00Life, Accident and HealthMiscellaneousNo Line SpecifiedGR Elected Official135Ins Co - Licensed/ActiveOrganizationINDV2426NATIONAL GENERAL ASSURANCE COMPANYInsuredDelays (Claims Handling); Denial Of Claim; Unsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-07-16T00:00:002012-09-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass7765Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; UNDERWRITING CRITERIA2427CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction; Information Furnished2012-07-12T00:00:002012-11-06T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured2851Self-Funded / ErisaOrganizationORGCHIROPRACTIC2428TIME INSURANCE COMPANYInsuredDenial Of ClaimYesClean Claims Violation; Additional Monies Received; Stat Pen Pd-Over 90 Dys Late2012-07-13T00:00:002012-08-29T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1374Ins Co - Licensed/ActiveOrganizationINDV2430FIDELITY NATIONAL TITLE INSURANCE COMPANYConsumer (Non-Insured)Delays (Policyholder Service)NoInformation Furnished2012-07-16T00:00:002012-08-31T00:00:00Property and CasualtyMiscellaneousTitle InsuranceInsured52226Ins Co - Licensed/ActiveOrganizationINDV2432STATE FARM LLOYDSInsuredDenial Of ClaimYesInformation Furnished; Additional Monies Received2012-07-16T00:00:002012-11-01T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVAPPRAISAL; BURDEN OF PROOF; DAMAGE DISPUTE; HAIL; ROOF; WATER DAMAGE2433LIBERTY COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled; Information Furnished; Additional Monies Received2012-07-16T00:00:002012-09-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass3762Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; SUPPLEMENTARY PAYMENT2435FOREMOST LLOYDS OF TEXASInsuredCust Service Claim HandlingNoInformation Furnished; Claim Settled2012-07-16T00:00:002012-09-18T00:00:00Property and CasualtyHomeownersHomeowners698Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING2436COMPANION PROPERTY AND CASUALTY INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished; Contract Language/Legal Issue2012-07-16T00:00:002012-09-21T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company10484Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF; DAMAGE DISPUTE; ROOF; UNDERWRITING CRITERIA2438OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled; Information Furnished2012-07-16T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Correspondent Person; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING2439OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld2012-07-16T00:00:002012-09-14T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company1823Ins Co - Licensed/ActiveOrganizationINDV2439MALIK, SURAYA NABIThird PartyCust Service Claim HandlingNoInformation Furnished2012-07-16T00:00:002012-09-14T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company891763Claims AdjusterIndividualINDV2440UNITEDHEALTHCARE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferYesClaim Settled2012-07-13T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured1348Ins Co - Licensed/ActiveOrganizationINDV2442ALLSTATE TEXAS LLOYD'SInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished; Question of Fact2012-07-11T00:00:002012-09-28T00:00:00Property and CasualtyHomeownersHomeowners3721Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; DEPRECIATION; GR-Claim Evaluation; HAIL; ROOF; WATER DAMAGE2444AMERICAN NATIONAL INSURANCE COMPANYInsuredDenial Of ClaimYesAdditional Monies Received2012-07-16T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life135Ins Co - Licensed/ActiveOrganizationINDV2445IMS MARKETING, INC.ProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-07-12T00:00:002012-09-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured6231Third Party AdministratorsOrganizationORG2446OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYAttorneyDelays (Claims Handling)YesClaim Settled2012-05-09T00:00:002012-09-07T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDV2449OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Company Position Upheld; Additional Payment Expected2012-07-16T00:00:002012-09-14T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; UNCOOPERATIVE INSURED2450AMERICAN MEDICAL AND LIFE INSURANCE COMPANYInsuredDelays (Claims Handling); Pre-Existing ConditionNoContract Language/Legal Issue2012-07-24T00:00:002012-10-18T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeGR Elected Official74Ins Co - Licensed/ActiveOrganizationINDV2450NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA.InsuredDelays (Claims Handling)NoContract Language/Legal Issue2012-07-24T00:00:002012-10-18T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeGR Elected Official1931Ins Co - Licensed/ActiveOrganizationINDV2451FOREMOST COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished; Claim Settled2012-07-16T00:00:002012-09-14T00:00:00Property and CasualtyHomeownersMobile Homeowner2530Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING2452STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoQuestion of Fact; Contract Language/Legal Issue2012-07-16T00:00:002012-10-01T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured; Third Party Admin-Non Licensed1510Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED2453NATIONAL INTERSTATE INSURANCE COMPANYThird PartyDenial Of ClaimNoContract Language/Legal Issue; Information Furnished; Question of Fact2012-07-16T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private Pass3548Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF2454TEXAS FARMERS INSURANCE COMPANYInsuredOtherYesInformation Furnished2012-07-16T00:00:002012-10-17T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDV2455FOREMOST LLOYDS OF TEXASInsuredDenial Of Claim; Non-RenewalYesAdditional Monies Received; Information Furnished; Claim Settled2012-07-16T00:00:002012-09-28T00:00:00Property and CasualtyHomeownersHomeowners698Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF2455ALLSTATE TEXAS LLOYD'SInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-07-16T00:00:002012-09-28T00:00:00Property and CasualtyHomeownersHomeowners3721Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF2456OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoCompany Position Upheld2012-07-16T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDV2459FIDELITY NATIONAL INSURANCE COMPANYInsuredDelays (Claims Handling)YesAdditional Monies Received; Claim Settled2012-07-16T00:00:002012-09-21T00:00:00Property and CasualtyHomeownersHomeowners17916Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING2459ANDERSON, CHRISTIAN FREDERICK IIIInsuredCust Service Claim HandlingYesInformation Furnished2012-07-16T00:00:002012-09-21T00:00:00Property and CasualtyHomeownersHomeowners660250Claims AdjusterIndividualINDVADJUSTER'S HANDLING2462PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-07-16T00:00:002012-09-14T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured1708Ins Co - Licensed/ActiveOrganizationINDVAFTERMARKET PARTS; APPRAISAL; GR-Claim Evaluation2463OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoAdditional Monies Received; Claim Settled2012-07-16T00:00:002012-10-01T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Injured EmployeeOrganizationINDV2467OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)NoClaim Settled; Additional Monies Received; Information Furnished2012-07-16T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation; LOSS OF USE; SUPPLEMENTARY PAYMENT2469TEXAS FARMERS INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished2012-07-13T00:00:002012-10-19T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person1452Ins Co - Licensed/ActiveOrganizationINDV2470FIRE INSURANCE EXCHANGEInsuredDelays (Policyholder Service); Premium NoticeYesPremium Refunded2012-11-02T00:00:002012-11-27T00:00:00Property and CasualtyHomeownersHomeownersInsured2606Ins Co - Licensed/ActiveOrganizationINDV2473CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-07-18T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORG2474DRIVER'S INSURANCE COMPANYRelativeCust Service Claim HandlingNoInsufficient Information2012-07-13T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2038Ins Co - Licensed/ActiveOrganizationINDV2477FIDELITY SECURITY LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-07-18T00:00:002012-11-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured2592Ins Co - Licensed/ActiveOrganizationORG2478AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesAdditional Monies Received; Information Furnished2012-07-18T00:00:002012-10-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG2479TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled2012-07-13T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass1450Ins Co - Licensed/ActiveOrganizationINDV2481AETNA LIFE INSURANCE COMPANYInsuredDelays (Claims Handling)NoNo Jurisdiction2012-07-18T00:00:002012-09-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV2482Premier Nationwide LendingAgentAgent HandlingYesInformation Furnished2012-07-13T00:00:002012-10-13T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent; Insured; Third Party Admin-Non Licensed67427Mortgage LenderOrganizationINDVBILL OF RIGHTS - HO2483GRAMERCY INSURANCE COMPANYConsumer (Non-Insured)OtherNoInsufficient Information2012-06-20T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass1062Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA2483SHANZE ENTERPRISES INC.Consumer (Non-Insured)Improper InducementsNoInsufficient Information2012-06-20T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass25945AgentOrganizationINDVUNDERWRITING CRITERIA2484BANKERS LIFE AND CASUALTY COMPANYInsuredDelays (Policyholder Service)NoPolicy Issued/Restored; Information Furnished2012-07-18T00:00:002012-11-09T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life3030Ins Co - Licensed/ActiveOrganizationINDV2486CONNECTICUT GENERAL LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction2012-07-18T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Ins Co - Licensed/ActiveOrganizationINDV2486CAREMARK, L.L.C.InsuredDenial Of ClaimNo2012-07-18T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H56496Third Party AdministratorsOrganizationINDV2487COLUMBIA LLOYDS INSURANCE COMPANYConsumer (Non-Insured)Unsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-07-13T00:00:002012-10-18T00:00:00Property and CasualtyHomeownersHomeowners3329Ins Co - Licensed/ActiveOrganizationORGROOF2489HARTFORD INSURANCE COMPANY OF THE MIDWESTThird PartyUnsatisfactory Settle/OfferNoAdditional Payment Expected; Information Furnished2012-07-13T00:00:002012-10-24T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied LinesAssociated Agent; Insured650Ins Co - Licensed/ActiveOrganizationINDV2492STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld2012-06-05T00:00:002012-08-22T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation2493AETNA LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished2012-07-18T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV2496VIRGINIA SURETY COMPANY, INC.InsuredOtherNoInsufficient Information2012-07-17T00:00:002012-10-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass649Ins Co - Licensed/ActiveOrganizationINDV2499AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-16T00:00:002012-09-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured245Ins Co - Licensed/ActiveOrganizationORG2503UNITED INSURANCE COMPANY OF AMERICABeneficiaryUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-07-19T00:00:002012-08-31T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person1299Ins Co - Licensed/ActiveOrganizationINDV2504INFINITY COUNTY MUTUAL INSURANCE COMPANYInsuredCancellation; Denial Of ClaimNoCompany Position Upheld; Information Furnished2012-07-16T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass1197Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation; UNDERWRITING CRITERIA2506FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredCust Service Claim HandlingNoInformation Furnished2012-07-24T00:00:002012-08-01T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDV2506CLARK, DAVID RAYInsuredAgent HandlingNoInformation Furnished2012-07-24T00:00:002012-08-01T00:00:00Property and CasualtyAutomobileIndividual Private Pass308311AgentIndividualINDV2508BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-19T00:00:002012-08-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2510ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished2012-07-17T00:00:002012-09-05T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured936Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; LOSS OF USE2511DEPOSITORS INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Additional Monies Received; Claim Settled2012-07-13T00:00:002012-10-25T00:00:00Property and CasualtyLiabilityGeneral LiabilityInsured; Insured Company3377Ins Co - Licensed/ActiveOrganizationINDV2511FREDERIKSEN & FREDERIKSEN A CORPThird PartyDelays (Claims Handling)NoInformation Furnished2012-07-13T00:00:002012-10-25T00:00:00Property and CasualtyLiabilityGeneral LiabilityInsured; Insured Company4412AgentOrganizationINDV2514METROPOLITAN LIFE INSURANCE COMPANYRelativeXX-Coverage QuestionNoContract Language/Legal Issue; Information Furnished2012-07-19T00:00:002012-09-28T00:00:00Life, Accident and HealthLife & AnnuityGroup LifeInsured13191Ins Co - Licensed/ActiveOrganizationINDV2515TEXAS MUNICIPAL LEAGUE INTERGOVERNMENTAL RISK POOLThird PartyUnsatisfactory Settle/OfferNoNo Jurisdiction; Additional Monies Received2012-07-18T00:00:002012-10-01T00:00:00Property and CasualtyAutomobileBusiness Automobile74153Govermental EntityOrganizationINDV2516OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received; Information Furnished; Claim Settled2012-07-18T00:00:002012-09-17T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING2517AMERICAN FAMILY LIFE ASSURANCE COMPANY OF COLUMBUSInsuredDelays (Claims Handling); Denial Of ClaimNoAdditional Monies Received2012-07-19T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2655Ins Co - Licensed/ActiveOrganizationINDV2517ALMANZA, CHRISTINA LOUISEInsuredMisrepresentationYesInformation Furnished2012-07-19T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H413478AgentIndividualINDV2518HARTFORD LIFE INSURANCE COMPANYInsuredNon-Disclosure Of Coverage; Not Within TDI Jurisdiction; OtherNoContract Language/Legal Issue; Referred To; No Jurisdiction2012-07-13T00:00:002012-10-04T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities1119Ins Co - Licensed/ActiveOrganizationINDV2522FINANCIAL AMERICAN PROPERTY AND CASUALTY INSURANCE COMPANYRelativeCancellation; Delays (Claims Handling)YesQuestion of Fact; Contract Language/Legal Issue2012-07-17T00:00:002012-10-18T00:00:00Life, Accident and HealthLife & AnnuityCredit Life2291Ins Co - Licensed/ActiveOrganizationINDV2523TRITON INSURANCE COMPANYInsuredDelays (Claims Handling)NoNo Jurisdiction; Information Furnished2012-07-18T00:00:002012-09-17T00:00:00Property and CasualtyMiscellaneousP & C Misc3322Ins Co - Licensed/ActiveOrganizationINDV2524SELECTCARE OF TEXAS, L.L.C.Contracted ProviderDenial Of ClaimNoInformation Furnished; No Jurisdiction2012-07-18T00:00:002012-09-19T00:00:00Medicare Managed Care for HMOAccident and HealthGroup A&HAssociated Subject Company; Correspondent Person; Insured14275Health Maintenance OrgOrganizationORG2526ALLSTATE PROPERTY AND CASUALTY INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoCompany Position Upheld; Question of Fact2012-07-18T00:00:002012-09-26T00:00:00Property and CasualtyMiscellaneousInland MarineAssociated Agent; Insured3463Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation2527ALLSTATE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld2012-07-19T00:00:002012-10-02T00:00:00Property and CasualtyHomeownersRental168Ins Co - Licensed/ActiveOrganizationINDV2528AMERICAN HOME SHIELDInsuredDenial Of ClaimNoReferred To2012-07-17T00:00:002012-10-26T00:00:00Property and CasualtyMiscellaneousWarranty Contract66787OtherOrganizationINDV2529PERRY, KAYE LYNNAgentCommissionsYesReferred for Disciplinary Actn2012-07-18T00:00:002012-10-15T00:00:00Property and CasualtyMiscellaneousNo Line SpecifiedCorrespondent Company887415AgentIndividualINDV2530ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished2012-07-18T00:00:002012-09-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED2531ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling)YesPremium Refunded2012-07-18T00:00:002012-09-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDV2532OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoContract Language/Legal Issue; Additional Payment Expected2012-07-18T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Third Party Admin-Non Licensed1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; UNCOOPERATIVE INSURED2534TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYConsumer (Non-Insured)Denial Of Claim; Liability DisputeNoQuestion of Fact2012-07-18T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured1450Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2536FIRE INSURANCE EXCHANGEInsuredDenial Of ClaimNoCompany Position Upheld2012-07-13T00:00:002012-10-05T00:00:00Property and CasualtyHomeownersHomeowners2606Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; ROOF; WATER DAMAGE2540CENTRAL UNITED LIFE INSURANCE COMPANYInsuredRefund Of PremiumYesNo Jurisdiction; Premium Refund2012-07-16T00:00:002012-08-21T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life947Ins Co - Licensed/ActiveOrganizationINDV2541JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.)InsuredPremium Notice; Refund Of PremiumNoRate Problem Resolved; Contract Language/Legal Issue2012-07-19T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1148Ins Co - Licensed/ActiveOrganizationINDV2542HUMANA INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction; Additional Monies Received2012-07-19T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company1040Ins Co - Licensed/ActiveOrganizationINDV2543AXA EQUITABLE LIFE AND ANNUITY COMPANYThird PartyOtherYesInformation Furnished2012-07-19T00:00:002012-08-16T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesInsured3391Ins Co - Licensed/ActiveOrganizationINDV2544HUMANA INSURANCE COMPANYProviderPrompt Pay; Unsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-07-17T00:00:002012-08-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORG2546UNITED OF OMAHA LIFE INSURANCE COMPANYInsuredCash Value; Delays (Policyholder Service)NoInformation Furnished; Premium Refunded2012-07-19T00:00:002012-09-24T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1281Ins Co - Licensed/ActiveOrganizationINDV2547BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoInsufficient Information2012-07-23T00:00:002012-08-15T00:00:00Health Maintenance OrgAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV2549HUMANA HEALTH PLAN OF TEXAS, INC.HospitalSB418 Rule ViolationNoClaim Not Clean; Information Furnished2012-07-17T00:00:002012-09-07T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Company; Correspondent Person; Insured702Ins Co - Licensed/ActiveOrganizationORG2550BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of Claim; SB418 Rule ViolationNoClaim Not Clean; Information Furnished2012-07-16T00:00:002012-11-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG2552UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDenial Of ClaimNoNo Jurisdiction2012-07-16T00:00:002012-08-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured1348Ins Co - Licensed/ActiveOrganizationINDV2553UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-17T00:00:002012-08-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG2554UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-07-16T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV2555UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDenial Of ClaimNoNo Jurisdiction2012-07-17T00:00:002012-08-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured1348Ins Co - Licensed/ActiveOrganizationINDV2556UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-07-17T00:00:002012-09-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG2557UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDenial Of Claim; SB418 Rule ViolationYesClean Claims Violation; Additional Monies Received2012-07-17T00:00:002012-09-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV2558METROPOLITAN LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; No Jurisdiction; Information Furnished2012-07-20T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&H13191Ins Co - Licensed/ActiveOrganizationINDV2559UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDenial Of ClaimNoNo Jurisdiction2012-07-17T00:00:002012-08-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured1348Ins Co - Licensed/ActiveOrganizationINDV2561UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDenial Of ClaimNoNo Jurisdiction2012-07-17T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured1348Ins Co - Licensed/ActiveOrganizationINDV2562UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDenial Of ClaimNoNo Jurisdiction2012-07-17T00:00:002012-08-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured1348Ins Co - Licensed/ActiveOrganizationINDV2565AETNA LIFE INSURANCE COMPANYProviderRecoupment Of Claims PaymentNoInformation Furnished2012-07-16T00:00:002012-08-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG2566TEXAS MUTUAL INSURANCE COMPANYNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-06-19T00:00:002012-10-24T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Company; Correspondent Person; Insured3500Ins Co - Licensed/ActiveOrganizationORG2567AETNA LIFE INSURANCE COMPANYProviderDenial Of ClaimNoAdditional Monies Received; Claim Settled2012-07-17T00:00:002012-09-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured245Ins Co - Licensed/ActiveOrganizationORG2570ALLSTATE INSURANCE COMPANYInsuredDelays (Claims Handling)NoClaim Settled; Information Furnished; Additional Monies Received2012-06-13T00:00:002013-02-04T00:00:00Property and CasualtyAutomobileIndividual Private Pass168Ins Co - Licensed/ActiveOrganizationINDV2574AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-16T00:00:002012-09-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG2575COVENTRY HEALTH AND LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-16T00:00:002012-08-29T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured98Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN2577SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.AttorneyOtherNoAdditional Monies Received; Information Furnished2012-05-29T00:00:002012-10-05T00:00:00Workers' CompensationAccident and HealthGroup A&HAssociated Subject Company; Insured34661Ins Co - Licensed/ActiveOrganizationINDV2578OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoClaim Settled; Information Furnished2012-07-18T00:00:002012-09-17T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; DAMAGE DISPUTE; SUPPLEMENTARY PAYMENT2579AMERICAN ACCESS CASUALTY COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferYesInformation Furnished; Additional Monies Received2012-07-18T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileIndividual Private Pass30332Ins Co - Licensed/ActiveOrganizationINDVTOTAL LOSS2580LOYA INSURANCE COMPANYInsuredOtherNoInformation Furnished2012-07-18T00:00:002012-09-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass15643Ins Co - Licensed/ActiveOrganizationINDV2581STATE FARM LLOYDSInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-07-18T00:00:002012-09-14T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVAPPRAISAL; BURDEN OF PROOF; DAMAGE DISPUTE; HAIL; ROOF; UNDERWRITING CRITERIA2582BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of Claim; Medical NecessityNoNo Jurisdiction2012-07-16T00:00:002012-09-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV2583GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished; Additional Payment Expected2012-07-18T00:00:002012-09-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE2584TEXAS FARMERS INSURANCE COMPANYOtherUnsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received2012-07-06T00:00:002012-09-24T00:00:00Property and CasualtyHomeownersHomeownersInsured1452Ins Co - Licensed/ActiveOrganizationORGHAIL; OVERHEAD AND PROFIT; ROOF2585REASSURE AMERICA LIFE INSURANCE COMPANYBeneficiaryDelays (Claims Handling)NoInformation Furnished2012-07-16T00:00:002012-10-17T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured1228Ins Co - Licensed/ActiveOrganizationINDV2586BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-16T00:00:002012-08-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company10047Ins Co - Licensed/ActiveOrganizationINDV2587CONNECTICUT GENERAL LIFE INSURANCE COMPANYInsuredCancellationNoNo Jurisdiction2012-07-18T00:00:002012-09-18T00:00:00Property and CasualtyLife & AnnuityIndividual Life2851Ins Co - Licensed/ActiveOrganizationINDV2588REASSURE AMERICA LIFE INSURANCE COMPANYInsuredCash Value; Delays (Policyholder Service)NoInformation Furnished2012-07-16T00:00:002012-10-17T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1228Ins Co - Licensed/ActiveOrganizationINDV2589JEFFERSON NATIONAL LIFE INSURANCE COMPANYRelativeDelays (Policyholder Service)NoInsufficient Information2012-07-16T00:00:002012-11-14T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company; Insured2439Ins Co - Licensed/ActiveOrganizationINDV2592BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-07-16T00:00:002012-10-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORGGRANDFATHERED HEALTH PLAN2593STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld2012-07-19T00:00:002012-11-26T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF2594DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished2012-07-18T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2038Ins Co - Licensed/ActiveOrganizationINDVDIMINISHED VALUE2595OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Claim Settled2012-07-18T00:00:002012-10-09T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; LOSS OF USE2596TEACHERS INSURANCE AND ANNUITY ASSOCIATION OF AMERICAInsuredDelays (Policyholder Service)YesInformation Furnished; Contract Language/Legal Issue2012-07-16T00:00:002012-12-14T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities1433Ins Co - Licensed/ActiveOrganizationINDV2597ELCO Administrative ServicesThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-07-18T00:00:002012-10-09T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured; Third Party Admin-Non Licensed68007Third Party AdministratorsOrganizationORGLOSS OF USE2598UNITEDHEALTHCARE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-16T00:00:002012-09-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV2599MERCURY COUNTY MUTUAL INSURANCE COMPANYLienholderDenial Of ClaimNoCompany Position Upheld2012-07-18T00:00:002012-09-07T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1693Ins Co - Licensed/ActiveOrganizationORG2600BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferNoInformation Furnished2012-07-16T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person; Insured10047Ins Co - Licensed/ActiveOrganizationINDV2602UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoClaim Not Clean; Additional Monies Received; Contract Language/Legal Issue2012-07-16T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured1348Ins Co - Licensed/ActiveOrganizationORGEXPERIMENTAL/INVESTIGATIONAL2603PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoAdditional Monies Received; Information Furnished; Contract Language/Legal Issue2012-07-17T00:00:002012-10-05T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVEXAM UNDER OATH2604BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-16T00:00:002012-08-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG2606UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimYesClaim Settled2012-07-16T00:00:002012-09-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2607DEARBORN NATIONAL LIFE INSURANCE COMPANYInsuredCash ValueNoContract Language/Legal Issue2012-07-16T00:00:002012-10-14T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1013Ins Co - Licensed/ActiveOrganizationINDV2609AETNA LIFE INSURANCE COMPANYPhysicianDelays (Claims Handling)YesClaim Settled2012-07-16T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2610CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDenial Of ClaimYesOther2012-07-16T00:00:002012-09-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation2611UNITEDHEALTHCARE INSURANCE COMPANYEmployerUnsatisfactory Settle/OfferNoInformation Furnished2012-07-16T00:00:002012-09-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV2612TRAVELERS LLOYDS OF TEXAS INSURANCE COMPANYInsuredDenial Of Claim; Liability DisputeNoInformation Furnished; Company Position Upheld2012-07-19T00:00:002012-09-28T00:00:00Property and CasualtyHomeownersHomeowners776Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; POLICY EXCLUSION2613GARRISON PROPERTY AND CASUALTY INSURANCE COMPANYThird PartyCust Service Claim HandlingNoInformation Furnished2012-07-19T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1697Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation2613MASSACHUSETTS BAY INSURANCE COMPANYThird PartyDelays (Claims Handling)YesInformation Furnished2012-07-19T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2111Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation2614LOYA INSURANCE COMPANYConsumer (Non-Insured)Denial Of ClaimNoCompany Position Upheld2012-07-25T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured15643Ins Co - Licensed/ActiveOrganizationORG2615UNDERWRITERS AT LLOYD'S, LONDONInsuredDelays (Claims Handling)NoCompany Position Upheld2012-07-19T00:00:002012-10-31T00:00:00Property and CasualtyHomeownersHomeowners55949Ins Co - Surplus LinesOrganizationINDVDEDUCTIBLE; DEPRECIATION; GR-Claim Evaluation; ROOF2616OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoClaim Settled; Information Furnished; Complainant Retained Attorney2012-05-07T00:00:002013-09-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNCOOPERATIVE INSURED2618FREEMAN, SCOTT HAMILTONInsuredMisrepresentationNoContract Language/Legal Issue; Question of Fact2012-07-16T00:00:002012-10-22T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities510200AgentIndividualINDV2619PHYSICIANS LIFE INSURANCE COMPANYBeneficiaryCust Service Claim Handling; Delays (Claims Handling)NoInformation Furnished; Additional Payment Expected2012-07-16T00:00:002012-10-26T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured1786Ins Co - Licensed/ActiveOrganizationINDV2620LIFE INSURANCE COMPANY OF NORTH AMERICAInsuredDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; Additional Payment Expected2012-07-02T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2157Ins Co - Licensed/ActiveOrganizationINDV2621TIME INSURANCE COMPANYInsuredCancellationYesAdditional Monies Received2012-07-16T00:00:002012-10-14T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company1374Ins Co - Licensed/ActiveOrganizationINDV2621PAYNE, AARON ALEXInsuredAgent HandlingYesContract Language/Legal Issue2012-07-16T00:00:002012-10-14T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company622680AgentIndividualINDV2622HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.InsuredDenial Of ClaimNoNo Jurisdiction2012-07-16T00:00:002012-09-12T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company27417Ins Co - Licensed/ActiveOrganizationINDV2623WASHINGTON NATIONAL INSURANCE COMPANYThird PartyDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-02-21T00:00:002012-12-04T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1196Ins Co - Licensed/ActiveOrganizationORG2623STATESIDE SENIOR SERVICES, LLC.Third PartyAgent HandlingNo2012-02-21T00:00:002012-12-04T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured27687Insurance AgencyOrganizationORG2624BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoNo Jurisdiction2012-07-17T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV2625TRANSAMERICA LIFE INSURANCE COMPANYBeneficiaryDelays (Policyholder Service)NoPolicy Issued/Restored; Corrective Action Taken2012-07-16T00:00:002012-08-31T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured1983Ins Co - Licensed/ActiveOrganizationINDV2627GEICO ADVANTAGE INSURANCE COMPANYInsuredRefund Of PremiumNoInformation Furnished2012-07-19T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileXX-State Specific63856Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA2629BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/Offer; Usual And CustomaryYesContract Language/Legal Issue; Additional Monies Received2012-07-26T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2635DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferYesAdditional Payment Expected; Claim Settled; Corrective Action Taken2012-07-19T00:00:002012-10-01T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING2637STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyLiability DisputeNoQuestion of Fact; Information Furnished2012-07-19T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company1510Ins Co - Licensed/ActiveOrganizationINDV2639BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredRefusal to InsureNoPolicy Issued/Restored; Information Furnished2012-07-20T00:00:002012-10-22T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationINDV2640FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYLienholderDenial Of Claim; Liability DisputeNoCompany Position Upheld; Question of Fact2012-07-19T00:00:002012-09-10T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2623Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2644ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling)YesAdditional Payment Expected; Additional Monies Received; Information Furnished2012-07-19T00:00:002012-08-14T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Person; Insured; Third Party Admin-Non Licensed9825Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; SUBROGATION2646GUARDIAN LIFE INSURANCE COMPANY OF AMERICA, THEInsuredCash Value; Delays (Claims Handling)NoInformation Furnished; Additional Payment Expected2012-07-26T00:00:002012-08-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2414Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2647SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIARelativeCust Service Claim Handling; Recoupment Of Claims PaymentNoInformation Furnished; Contract Language/Legal Issue2011-10-21T00:00:002012-12-04T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured3587Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN2649AETNA LIFE INSURANCE COMPANYProviderSB418 Rule ViolationNoInformation Furnished; Contract Language/Legal Issue2012-07-18T00:00:002012-09-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG2650HERTZ CLAIM MANAGEMENTThird PartyDelays (Claims Handling)NoContract Language/Legal Issue; Information Furnished2012-07-19T00:00:002012-11-07T00:00:00Property and CasualtyAutomobileIndividual Private Pass13349AgentOrganizationINDVADJUSTER'S HANDLING2653HARTFORD INSURANCE COMPANY OF THE MIDWESTInsuredPremium and RatingYesInformation Furnished2012-07-17T00:00:002012-09-07T00:00:00Property and CasualtyMiscellaneousWorkers' Compensation650Ins Co - Licensed/ActiveOrganizationORG2655PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)YesClaim Settled; Additional Monies Received2012-07-19T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; HAIL; SUPPLEMENTARY PAYMENT2657CHURCH MUTUAL INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling); Denial Of ClaimNoQuestion of Fact; Information Furnished2012-07-19T00:00:002012-10-10T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines3210Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; BURDEN OF PROOF2659UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-07-17T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV2660BERKLEY REGIONAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoQuestion of Fact; Information Furnished2012-07-18T00:00:002012-12-11T00:00:00Property and CasualtyMiscellaneousFidelity & SuretyInsured Company3745Ins Co - Licensed/ActiveOrganizationORG2661FARMERS INSURANCE EXCHANGEInsuredDelays (Claims Handling)NoInformation Furnished; Question of Fact2012-07-19T00:00:002012-08-21T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person2668Ins Co - Licensed/ActiveOrganizationINDVBILL OF RIGHTS - HO; GR-Claim Evaluation; HAIL; ROOF2664ATLANTIC CASUALTY INSURANCE COMPANYThird PartyDenial Of ClaimNoPolicy Not In Force; Information Furnished2012-07-19T00:00:002012-11-29T00:00:00Property and CasualtyLiabilityGeneral Liability52002Ins Co - Surplus LinesOrganizationINDVGR-Claim Evaluation2668Old Republic Title Company of ConroeConsumer (Non-Insured)Cust Service Claim HandlingNoRecord Only2012-06-15T00:00:002012-09-19T00:00:00Property and CasualtyMiscellaneousTitle Insurance67515AgentOrganizationINDV2669UNITEDHEALTHCARE INSURANCE COMPANYInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferNoInformation Furnished2012-07-20T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDVPRESCRIPTION2670METROPOLITAN LIFE INSURANCE COMPANYInsuredDelays (Policyholder Service)NoNo Jurisdiction2012-07-18T00:00:002012-09-27T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesAssociated Subject Company13191Ins Co - Licensed/ActiveOrganizationINDV2671PACHICANO, TRINIDADInsuredAgent Handling; ConversionYesInformation Furnished; Referred for Disciplinary Actn; Failure to Timely Respond2012-06-25T00:00:002012-11-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass662788AgentIndividualINDV2672BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoContract Language/Legal Issue; Claim Not Clean2012-07-18T00:00:002012-10-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG2673UNITEDHEALTHCARE INSURANCE COMPANYPhysicianUnsatisfactory Settle/OfferNoInformation Furnished2012-07-18T00:00:002012-10-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Self-Funded / ErisaOrganizationINDV2676BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderSB418 Rule Violation; Unsatisfactory Settle/OfferNoClaim Not Clean2012-07-18T00:00:002012-12-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG2678AETNA LIFE INSURANCE COMPANYPhysicianUnsatisfactory Settle/OfferNoNo Jurisdiction; Contract Language/Legal Issue; Information Furnished2012-07-18T00:00:002012-10-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDVMULTIPLE INSUREDS2685AETNA LIFE INSURANCE COMPANYInsuredDelays (Policyholder Service)NoNo Jurisdiction; Information Furnished2012-07-25T00:00:002012-08-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDV2686BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONRelativeUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-25T00:00:002012-08-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV2688BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoClaim Not Clean; Information Furnished2012-07-18T00:00:002012-09-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG2689CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANYProviderDelays (Claims Handling)NoAdditional Monies Received; No Jurisdiction2012-07-18T00:00:002012-09-26T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured25422Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN2690AETNA LIFE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-18T00:00:002012-09-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company245Ins Co - Licensed/ActiveOrganizationINDV2691PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYProviderDelays (Claims Handling)NoInformation Furnished2012-07-19T00:00:002012-11-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDV2693BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue; No Jurisdiction2012-07-18T00:00:002012-10-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDVMULTIPLE INSUREDS2695FAMILY LIFE INSURANCE COMPANYRelativeDelays (Claims Handling); Delays (Policyholder Service)NoAdditional Monies Received; Information Furnished2012-07-18T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured2657Ins Co - Licensed/ActiveOrganizationINDV2696DEARBORN NATIONAL LIFE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-07-18T00:00:002012-10-04T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured1013Ins Co - Licensed/ActiveOrganizationORG2697UNITEDHEALTHCARE INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction2012-07-18T00:00:002012-09-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV2698BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-07-18T00:00:002012-09-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2699AMERICO FINANCIAL LIFE AND ANNUITY INSURANCE COMPANYRelativeAgent HandlingNoInformation Furnished2012-06-27T00:00:002012-11-16T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Person2897Ins Co - Licensed/ActiveOrganizationINDV2699WALLACE, CATHY ELAINERelativeAgent HandlingNoInformation Furnished2012-06-27T00:00:002012-11-16T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Person727222AgentIndividualINDV2700TIME INSURANCE COMPANYInsuredDenial Of ClaimNoClaim Settled2012-07-18T00:00:002012-10-17T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company1374Ins Co - Licensed/ActiveOrganizationINDV2701GUARANTEE INSURANCE COMPANYAttorneyBalance Billing; Cust Service Claim Handling; DWC Other; OtherNoCompany Position Upheld2012-07-23T00:00:002012-09-07T00:00:00Workers' CompensationMiscellaneousWorkers' CompensationInsured Company1104Ins Co - Licensed/ActiveOrganizationORG2702MOLINA HEALTHCARE OF TEXAS, INC.ProviderOtherYesInformation Furnished2012-07-18T00:00:002012-09-28T00:00:00Health Maintenance OrgAccident and HealthXX-State SpecificCorrespondent Person23469Health Maintenance OrgOrganizationORG2703CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-07-18T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationINDVMULTIPLE INSUREDS2704JAY GUTIERREZ INSURANCE AGENCY, INC.AgentAgent HandlingNoInsufficient Information2012-07-16T00:00:002012-08-24T00:00:00Property and CasualtyHomeownersHomeowners64035AgentOrganizationINDV2706SANTA FE AUTO INSURANCE COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld2012-07-25T00:00:002012-08-27T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured27766Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING2707HUMANA HEALTH PLAN OF TEXAS, INC.ProviderDenial Of ClaimYesNo Jurisdiction; Additional Monies Received2012-07-23T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured702Health Maintenance OrgOrganizationINDV2709AMERICAN MEDICAL SECURITY LIFE INSURANCE COMPANYInsuredDelays (Policyholder Service)NoInformation Furnished2012-07-18T00:00:002012-09-28T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life3652Ins Co - Licensed/ActiveOrganizationINDV2711STONEBRIDGE LIFE INSURANCE COMPANYInsuredRecoupment Of Claims PaymentYesClaim Settled; Contract Language/Legal Issue2012-07-18T00:00:002012-09-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2269Ins Co - Licensed/ActiveOrganizationINDV2712PROGRESSIVE PREFERRED INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished2012-07-19T00:00:002012-10-21T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured3382Ins Co - Licensed/ActiveOrganizationINDV2713FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoQuestion of Fact2012-07-19T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVDIMINISHED VALUE; GR-Claim Evaluation2714AETNA LIFE INSURANCE COMPANYProviderDenial Of ClaimNoInformation Furnished; No Jurisdiction2012-07-16T00:00:002012-08-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person; Insured245Ins Co - Licensed/ActiveOrganizationORG2715IDS PROPERTY CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received2012-07-19T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured3610Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2716CONSUMERS COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished2012-07-27T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass2806Ins Co - Licensed/ActiveOrganizationINDV2717PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished; Corrective Action Taken2012-07-19T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDV2718LIBERTY INSURANCE CORPORATIONInsuredDenial Of ClaimYesInformation Furnished; Additional Monies Received2012-07-13T00:00:002012-09-06T00:00:00Property and CasualtyHomeownersHomeowners3636Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation2719UNUM LIFE INSURANCE COMPANY OF AMERICAInsuredRecoupment Of Claims Payment; Unsatisfactory Settle/OfferNoOverpaid Claim Recouped; Contract Language/Legal Issue2012-07-27T00:00:002012-08-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HGR Elected Official1327Ins Co - Licensed/ActiveOrganizationINDV2720INFINITY COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoAdditional Monies Received2012-07-16T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass1197Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation2724UNITEDHEALTHCARE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferYesClaim Settled2012-07-18T00:00:002012-12-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV2725CHURCH MUTUAL INSURANCE COMPANYInsuredNon-RenewalNoContract Language/Legal Issue; Information Furnished2012-07-16T00:00:002012-10-09T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied LinesInsured3210Ins Co - Licensed/ActiveOrganizationORG2726UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of Claim; SB418 Rule ViolationYesAdditional Monies Received; Information Furnished2012-07-18T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured1348Ins Co - Licensed/ActiveOrganizationORG2727BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished2012-07-18T00:00:002012-08-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2728BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/Offer; Usual And CustomaryNoNo Jurisdiction; Company Position Upheld2012-07-18T00:00:002012-08-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2729PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyInsurer FraudNoCompany Position Upheld2012-07-16T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1708Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation2730BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/Offer; Usual And CustomaryNoNo Jurisdiction2012-07-18T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2731CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesClaim Settled2012-07-18T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation2732BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/Offer; Usual And CustomaryNoContract Language/Legal Issue2012-07-18T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2733GREAT AMERICAN LIFE INSURANCE COMPANYConsumer (Non-Insured)MisrepresentationYesInformation Furnished2012-07-18T00:00:002012-11-13T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H720Ins Co - Licensed/ActiveOrganizationINDV2734HCC LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoClaim Settled; Additional Monies Received2012-07-18T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life672Ins Co - Licensed/ActiveOrganizationINDV2735UNITEDHEALTHCARE INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction2012-07-18T00:00:002012-08-30T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1348Ins Co - Licensed/ActiveOrganizationINDV2736BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoNo Jurisdiction; Information Furnished2012-07-18T00:00:002012-08-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2738BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-07-18T00:00:002012-09-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG2739CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-07-18T00:00:002012-09-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORG2740CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-18T00:00:002012-09-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORG2741ALLSTATE TEXAS LLOYD'SInsuredDenial Of ClaimNoCompany Position Upheld; Information Furnished2012-07-26T00:00:002012-09-26T00:00:00Property and CasualtyHomeownersHomeowners3721Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; HAIL2742HEALTHFIRST TPA, INC.ProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-07-18T00:00:002012-09-06T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured44234Third Party AdministratorsOrganizationORG2743BANKERS LIFE AND CASUALTY COMPANYInsuredDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-07-11T00:00:002012-09-28T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H3030Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; SENIOR CITIZEN2744BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-18T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Self-Funded / ErisaOrganizationORG2745BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished; Contract Language/Legal Issue2012-07-18T00:00:002012-09-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company; Insured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation2749STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Additional Payment Expected2012-07-26T00:00:002012-08-24T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF; COMPARATIVE NEGLIGENCE; GR-Claim Evaluation; LOSS OF USE2750LOYA INSURANCE COMPANYRelativePremium and RatingNoInformation Furnished2012-07-26T00:00:002012-09-14T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person15643Ins Co - Licensed/ActiveOrganizationINDV2751BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-18T00:00:002012-08-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2752WARRANTY UNDERWRITERS INSURANCE COMPANYInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferNoOther2012-07-20T00:00:002012-09-17T00:00:00Property and CasualtyHomeownersHomeowners921Ins Co - Licensed/ActiveOrganizationINDV2753The Accurate Group of Texas, LLCConsumer (Non-Insured)Cust Service Claim HandlingYesClaim Settled2012-07-20T00:00:002012-08-29T00:00:00Property and CasualtyMiscellaneousTitle InsuranceAssociated Subject Person67581AgentOrganizationORG2754BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of Claim; Unsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-07-18T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company; Insured10047Ins Co - Licensed/ActiveOrganizationORGBUNDLING; GR-Claim Evaluation2755AETNA LIFE INSURANCE COMPANYProviderDenial Of Claim; Denial Of Pymt For Emerg Care; Medical Necessity; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-18T00:00:002012-08-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company; Insured245Ins Co - Licensed/ActiveOrganizationORGBUNDLING; EMERGENCY CARE; GR-Claim Evaluation2756OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld; Question of Fact2012-07-24T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; LOSS OF USE2757BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-07-18T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2758AETNA LIFE INSURANCE COMPANYProviderDenial Of Pymt For Emerg Care; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-18T00:00:002012-09-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company; Insured245Ins Co - Licensed/ActiveOrganizationORGEMERGENCY CARE2759UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoInformation Furnished; No Jurisdiction2012-07-19T00:00:002012-09-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG2760CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderMedical Necessity; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-18T00:00:002012-10-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company; Insured2851Ins Co - Licensed/ActiveOrganizationORGBUNDLING2761NATIONAL LLOYDS INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling)NoCompany Position Upheld2012-07-20T00:00:002012-10-25T00:00:00Property and CasualtyHomeownersHomeownersCorrespondent Person1914Ins Co - Licensed/ActiveOrganizationINDVROOF; SENIOR CITIZEN; WATER DAMAGE2762UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of Claim; Medical Necessity; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-19T00:00:002012-09-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation2763NICKELS, RYAN THOMASInsuredPremium and RatingNoCompany Position Upheld2012-07-20T00:00:002012-10-31T00:00:00Property and CasualtyHomeownersHomeowners466449AgentIndividualINDVDEDUCTIBLE2764BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredOtherNoCompany Position Upheld2012-07-30T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Associated Subject Person10047Ins Co - Licensed/ActiveOrganizationINDV2766UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of Claim; Medical Necessity; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-19T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation2767SAFECO INSURANCE COMPANY OF INDIANAOtherUnsatisfactory Settle/OfferNoInformation Furnished; Complainant Retained Attorney; Additional Payment Expected2012-07-17T00:00:002012-10-05T00:00:00Property and CasualtyHomeownersHomeownersInsured2496Ins Co - Licensed/ActiveOrganizationORGDAMAGE DISPUTE; FOUNDATION ; GR-Claim Evaluation; HAIL; SLAB2769HOUSTON CASUALTY COMPANYInsuredDelays (Claims Handling)NoInformation Furnished; Complainant Retained Attorney2012-07-16T00:00:002012-10-05T00:00:00Property and CasualtyLiabilityGeneral LiabilityCorrespondent Person846Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING2770TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredPremium and RatingNoCompany Position Upheld; Information Furnished2012-07-16T00:00:002012-10-10T00:00:00Property and CasualtyHomeownersHomeowners1444Ins Co - Licensed/ActiveOrganizationINDV2771BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderRecoupment Of Claims PaymentNoOverpaid Claim Recouped2012-07-16T00:00:002012-09-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation2772TEXAS FARM BUREAU CASUALTY INSURANCE COMPANYThird PartyDenial Of ClaimNoClaim Settled; Information Furnished; Additional Monies Received2012-07-16T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured28440Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2773GOEN & GOEN INCInsuredAgent Handling; Unsatisfactory Settle/OfferNoInformation Furnished2012-07-16T00:00:002012-10-19T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent8664Insurance AgencyOrganizationINDVGR-Claim Evaluation; ROOF2775ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredCancellation; OtherNoInformation Furnished; Cancel/Non-Renewal Upheld2012-07-16T00:00:002012-10-09T00:00:00Property and CasualtyHomeownersHomeowners936Ins Co - Licensed/ActiveOrganizationINDV2776BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of Claim; Recoupment Of Claims Payment; Unsatisfactory Settle/OfferYesAdditional Monies Received2012-07-16T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGBUNDLING; GR-Claim Evaluation2777NATIONWIDE MUTUAL FIRE INSURANCE COMPANYInsuredRefund Of PremiumYesPremium Refunded; Information Furnished2012-07-16T00:00:002012-10-09T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent1936Ins Co - Licensed/ActiveOrganizationINDV2778PILLAR INSURANCE COMPANYInsuredOtherNoCompany Position Upheld; Information Furnished2012-07-16T00:00:002012-10-11T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency; Associated Subject Company15080Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN2779STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredCancellation; Non-RenewalNoCompany Position Upheld2012-07-16T00:00:002012-10-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV2781AETNA LIFE INSURANCE COMPANYProviderMedical Necessity; Recoupment Of Claims Payment; Unsatisfactory Settle/OfferNoCompany Position Upheld2012-07-16T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation; MULTIPLE INSUREDS2782ACCC INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoClaim Settled; Information Furnished2012-07-16T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured9825Ins Co - Licensed/ActiveOrganizationINDVDIMINISHED VALUE; GR-Claim Evaluation2784AMERICAN RISK INSURANCE COMPANY, INC.InsuredDenial Of Claim; OtherYesQuestion of Fact; Information Furnished2012-07-16T00:00:002012-11-07T00:00:00Property and CasualtyHomeownersHomeowners27377Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; MOLD; WATER DAMAGE2785AETNA HEALTH INC.ProviderUnsatisfactory Settle/OfferNoInformation Furnished2012-07-16T00:00:002012-08-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company; Insured3522Health Maintenance OrgOrganizationORGEMERGENCY CARE; GR-Claim Evaluation2786ALLSTATE COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received; Company Position Upheld2012-07-16T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent2228Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; REPLACEMENT VEHICLE2787CONSUMERS COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished2012-07-16T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass2806Ins Co - Licensed/ActiveOrganizationINDV2788GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Question of Fact2012-07-16T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDV2789UNITEDHEALTHCARE INSURANCE COMPANYProviderMedical Necessity; Recoupment Of Claims Payment; Unsatisfactory Settle/OfferYesInformation Furnished; Clean Claims Violation; Stat Pen Pd-Up To 45 Dys Late2012-07-16T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation2790UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of Claim; Unsatisfactory Settle/OfferNoNo Jurisdiction; Contract Language/Legal Issue; Information Furnished2012-07-16T00:00:002012-09-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGBUNDLING; GR-Claim Evaluation2791UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-30T00:00:002012-08-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured1348Ins Co - Licensed/ActiveOrganizationORG2792UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-07-16T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGBUNDLING2793HEALTHFIRST TPA, INC.ProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-07-16T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured44234Third Party AdministratorsOrganizationORG2794ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoAdditional Payment Expected; Claim Settled2012-07-17T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured936Ins Co - Licensed/ActiveOrganizationINDVCHIROPRACTIC; DAMAGE DISPUTE; GR-Claim Evaluation2795MUTUAL OF OMAHA INSURANCE COMPANYOtherUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-16T00:00:002013-02-07T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1977Ins Co - Licensed/ActiveOrganizationORG2796GROUP & PENSION ADMINISTRATORS, INC.ProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-16T00:00:002013-01-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured32390Self-Funded / ErisaOrganizationORG2797MEDICO INSURANCE COMPANYProviderRecoupment Of Claims PaymentNoInformation Furnished2012-07-16T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1980Ins Co - Licensed/ActiveOrganizationORG2798AAA BONDING AGENCY INCInsuredPremium NoticeNoInformation Furnished; Referred To2012-07-17T00:00:002012-09-11T00:00:00Property and CasualtyMiscellaneousFidelity & Surety11127AgentOrganizationINDV2799HUMANA INSURANCE COMPANYProviderRecoupment Of Claims Payment; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-16T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORG2802STATE FARM LLOYDSInsuredUnsatisfactory Settle/OfferYesInformation Furnished; Additional Monies Received2012-07-20T00:00:002012-09-10T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; DEPRECIATION; GR-Claim Evaluation; TOTAL LOSS2803CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-16T00:00:002012-09-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORG2805OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYAttorneyUnsatisfactory Settle/OfferNoAdditional Payment Expected; Information Furnished2012-07-17T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Person; Insured1823Ins Co - Licensed/ActiveOrganizationORG2809MOLINA HEALTHCARE OF TEXAS, INC.Third PartyUnsatisfactory Settle/OfferNoFailure to Timely Respond; No Jurisdiction; Information Furnished2012-07-16T00:00:002012-10-31T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Person; Insured23469Health Maintenance OrgOrganizationORG2811BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderMedical Necessity; Recoupment Of Claims PaymentNoAdditional Monies Received2012-07-16T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation2812PARKLAND COMMUNITY HEALTH PLAN, INC., A PROGRAM OF DALLAS COUNTY HOSPITAL DISTRICTProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-07-16T00:00:002012-09-14T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Person; Insured8254Health Maintenance OrgOrganizationORG2813FOREMOST COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Liability DisputeNoAdditional Payment Expected2012-07-20T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private Pass2530Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING2814STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYRelativeNon-RenewalYesAdditional Monies Received; Non-Renewal Rescinded2012-07-20T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured1510Ins Co - Licensed/ActiveOrganizationINDVHAIL2815UNITED STATES FIRE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoAdditional Monies Received2012-07-20T00:00:002012-10-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass50626Ins Co - Licensed/ActiveOrganizationINDV2816SUPERIOR HEALTHPLAN, INC.Third PartyDenial Of Claim; Unsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-07-16T00:00:002012-09-21T00:00:00Health Maintenance OrgAccident and HealthIndividual A & HCorrespondent Person; Insured10198Health Maintenance OrgOrganizationORG2821TEXAS MUNICIPAL LEAGUE INTERGOVERNMENTAL RISK POOLProviderNot Within TDI JurisdictionNoNo Jurisdiction2012-07-16T00:00:002012-08-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured34855OtherOrganizationORG2825STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished2012-07-20T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent1510Ins Co - Licensed/ActiveOrganizationINDVTOTAL LOSS; UNDERWRITING CRITERIA2826STATE FARM LLOYDSInsuredUnsatisfactory Settle/OfferYesInformation Furnished; Contract Language/Legal Issue2012-07-20T00:00:002012-10-13T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; HAIL; ROOF; SENIOR CITIZEN2827DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-07-20T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2038Ins Co - Licensed/ActiveOrganizationINDV2828BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-19T00:00:002012-08-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV2830PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Policyholder Service); Premium and RatingNoPremium Refunded2012-07-18T00:00:002012-10-01T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDV2832SOUTHWEST LIFE & HEALTH INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-16T00:00:002012-08-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured2041Ins Co - Licensed/ActiveOrganizationORG2833OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferYesAdditional Monies Received; Claim Settled2012-07-18T00:00:002012-11-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVACV; GR-Claim Evaluation2835OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoCompany Position Upheld2012-07-16T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDV2836PROGRESSIVE PREFERRED INSURANCE COMPANYRelativeDelays (Claims Handling)NoCompany Position Upheld2012-07-20T00:00:002012-10-21T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured3382Ins Co - Licensed/ActiveOrganizationINDV2837BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-07-12T00:00:002012-08-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation; MULTIPLE INSUREDS2839UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-23T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured1348Ins Co - Licensed/ActiveOrganizationORG2840ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Additional Monies Received; Claim Settled2012-07-18T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured9825Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; UNCOOPERATIVE INSURED2841UNITED HEALTHCARE SERVICES, INC.InsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-23T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&H36825Third Party AdministratorsOrganizationINDV2842STATE FARM LLOYDSOtherUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Company Position Upheld2012-07-20T00:00:002012-09-20T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent; Insured3105Ins Co - Licensed/ActiveOrganizationINDVDEPRECIATION; ROOF2843UNION SECURITY INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-07-23T00:00:002012-10-17T00:00:00Life, Accident and HealthLife & AnnuityGroup LifeAssociated Subject Company; Deceased Person1215Ins Co - Licensed/ActiveOrganizationINDV2844CAPITOL SECURITY LIFE INSURANCE COMPANYRelativeCash Value; Refund Of PremiumNoContract Language/Legal Issue; Information Furnished2012-07-23T00:00:002012-09-27T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2349Ins Co - Licensed/ActiveOrganizationINDV2846STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredPremium NoticeNoInformation Furnished; Corrective Action Taken2012-07-18T00:00:002012-10-09T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent1510Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN2846BROOKSHIRE, KEITH BRANDONInsuredPremium NoticeYesInformation Furnished2012-07-18T00:00:002012-10-09T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent852923AgentIndividualINDVSENIOR CITIZEN2847UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoContract Language/Legal Issue; Company Position Upheld2012-07-23T00:00:002012-11-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person1348Ins Co - Licensed/ActiveOrganizationORG2852BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-07-23T00:00:002012-09-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2855ALLSTATE INSURANCE COMPANYConsumer (Non-Insured)Use of Credit ReportsNoInformation Furnished; Company Position Upheld2012-07-18T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private Pass168Ins Co - Licensed/ActiveOrganizationINDVCREDIT REPORT2857GUIDEONE ELITE INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; Company Position Upheld2012-07-23T00:00:002012-10-22T00:00:00Property and CasualtyLiabilityGeneral Liability3488Ins Co - Licensed/ActiveOrganizationORGCOVERAGE DISPUTE2858AMERICA FIRST INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished2012-07-18T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass16071Ins Co - Licensed/ActiveOrganizationINDV2859HUMANA INSURANCE COMPANYProviderDelays (Claims Handling)YesClaim Settled2012-07-23T00:00:002012-09-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040OtherOrganizationINDVGR-Claim Evaluation2860TRAVELERS HOME AND MARINE INSURANCE COMPANY, THEInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-07-21T00:00:002012-10-16T00:00:00Property and CasualtyHomeownersCondominium3875Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; WATER DAMAGE2861STATE FARM FIRE AND CASUALTY COMPANYInsuredNon-RenewalNoInformation Furnished2012-07-23T00:00:002012-09-10T00:00:00Property and CasualtyLiabilityUmbrella1507Ins Co - Licensed/ActiveOrganizationINDV2862METROPOLITAN LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction2012-07-19T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&H13191Ins Co - Licensed/ActiveOrganizationINDV2863DELTA DENTAL INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-07-23T00:00:002012-09-05T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured2752Ins Co - Licensed/ActiveOrganizationINDV2865GROUP & PENSION ADMINISTRATORS, INC.InsuredDenial Of ClaimNoNo Jurisdiction2012-07-23T00:00:002012-08-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company32390Third Party AdministratorsOrganizationINDV2866GLOBE LIFE AND ACCIDENT INSURANCE COMPANYInsuredPremium and RatingNoRate Problem Resolved2012-07-19T00:00:002012-10-02T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured917Ins Co - Licensed/ActiveOrganizationINDVADVERTISING2868LIBERTY MUTUAL FIRE INSURANCE COMPANYInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished2012-07-19T00:00:002012-10-19T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent2209Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; SENIOR CITIZEN; WATER DAMAGE2869BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)YesClaim Settled2012-07-19T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation; MULTIPLE INSUREDS2870STATE FARM LLOYDSThird PartyUnsatisfactory Settle/OfferNoQuestion of Fact2012-07-18T00:00:002012-08-31T00:00:00Property and CasualtyHomeownersRental3105Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2871HUMANA HEALTH PLAN OF TEXAS, INC.InsuredDenial Of ClaimYesAdditional Monies Received; Contract Language/Legal Issue2012-07-20T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&H702Ins Co - Licensed/ActiveOrganizationINDV2872BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling); Usual And CustomaryNoInformation Furnished; Contract Language/Legal Issue; Additional Monies Received2012-07-19T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2875CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANYProviderDenial Of ClaimNoAdditional Payment Expected; Additional Monies Received; No Jurisdiction2012-07-23T00:00:002012-10-29T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured25422Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN2876BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoNo Jurisdiction2012-07-19T00:00:002012-08-30T00:00:00Employee Retirement SystemAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV2879DAIRYLAND COUNTY MUTUAL INSURANCE COMPANY OF TEXASThird PartyDelays (Claims Handling); Denial Of ClaimNoCompany Position Upheld; Information Furnished2012-07-16T00:00:002012-10-21T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2737Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; SENIOR CITIZEN2880BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-07-19T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationORG2881OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDelays (Claims Handling)NoCompany Position Upheld; Information Furnished2012-07-23T00:00:002012-09-20T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2882SAFECO INSURANCE COMPANY OF INDIANAInsuredDenial Of ClaimNoContract Language/Legal Issue2012-07-23T00:00:002012-09-21T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent; Insured2496Ins Co - Licensed/ActiveOrganizationINDV2012 NORTH TEXAS TORNADOES; ADJUSTER'S HANDLING; HAIL2883BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoInformation Furnished2012-07-19T00:00:002012-09-06T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationINDV2884HUMANADENTAL INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesClaim Settled2012-07-19T00:00:002013-01-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1182Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation2885RELIABLE LIFE INSURANCE COMPANY, THEInsuredCash Value; Delays (Policyholder Service)NoInformation Furnished; Premium Refunded2012-07-19T00:00:002012-09-06T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1704Ins Co - Licensed/ActiveOrganizationINDV2887COVENTRY HEALTH AND LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction2012-07-19T00:00:002012-11-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Associated Subject Person98Ins Co - Licensed/ActiveOrganizationINDV2888HUMANA HEALTH PLAN OF TEXAS, INC.Contracted ProviderUnsatisfactory Settle/OfferNoAdditional Monies Received; No Jurisdiction; Information Furnished2012-07-31T00:00:002012-11-12T00:00:00Medicare HMOAccident and HealthGroup A&HInsured702Health Maintenance OrgOrganizationORGSENIOR CITIZEN2890HUMANA INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-31T00:00:002012-11-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORG2892UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of Claim; Medical NecessityNoContract Language/Legal Issue; Information Furnished2012-07-18T00:00:002012-09-06T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured1348Ins Co - Licensed/ActiveOrganizationORG2893DRIVER'S INSURANCE COMPANYAttorneyDelays (Claims Handling)NoCompany Position Upheld; Information Furnished; Additional Payment Expected2012-07-23T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2038Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING2895BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-19T00:00:002012-08-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG2896SUPERIOR HEALTHPLAN, INC.ProviderDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-07-18T00:00:002012-10-31T00:00:00Health Maintenance OrgAccident and HealthGroup A&HAssociated Subject Company; Insured10198Health Maintenance OrgOrganizationORG2897HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished2012-07-23T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass2362Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2899State Farm FloodInsuredRefund Of PremiumYesNo Jurisdiction2012-07-23T00:00:002012-10-16T00:00:00Property and CasualtyMiscellaneousFederal Flood75391OtherOrganizationINDV2899SMITH, OWEN MARKInsuredRefund Of PremiumNoInformation Furnished2012-07-23T00:00:002012-10-16T00:00:00Property and CasualtyMiscellaneousFederal Flood78911AgentIndividualINDV2901AMERIGROUP TEXAS, INC.HospitalMedical Necessity; Unsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-07-18T00:00:002012-09-11T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Company; Correspondent Person; Insured8032Health Maintenance OrgOrganizationORG2902BANKERS LIFE AND CASUALTY COMPANYRelativeDelays (Claims Handling)NoPolicy Issued/Restored2012-07-19T00:00:002012-11-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured3030Ins Co - Licensed/ActiveOrganizationINDV2903GEICO INDEMNITY COMPANYInsuredUnsatisfactory Settle/OfferYesInformation Furnished; Additional Payment Expected2012-07-23T00:00:002012-10-04T00:00:00Property and CasualtyAutomobileIndividual Private Pass2785Ins Co - Licensed/ActiveOrganizationINDV2904AMERIGROUP TEXAS, INC.ProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-19T00:00:002012-08-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured8032Health Maintenance OrgOrganizationORG2905AETNA LIFE INSURANCE COMPANYProviderDenial Of Claim; Medical NecessityNoNo Jurisdiction2012-07-19T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORGEXPERIMENTAL/INVESTIGATIONAL; GR-Claim Evaluation2906ALLSTATE INDEMNITY COMPANYConsumer (Non-Insured)Unsatisfactory Settle/OfferNoQuestion of Fact2012-07-23T00:00:002012-09-14T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person167Ins Co - Licensed/ActiveOrganizationINDVACV; COMPARATIVE NEGLIGENCE; GR-Claim Evaluation; TOTAL LOSS2907UNITEDHEALTHCARE INSURANCE COMPANYInsuredAccess to Care; Denial Of Claim; Medical NecessityNoCompany Position Upheld2012-07-19T00:00:002012-11-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation2908PRINCIPAL LIFE INSURANCE COMPANYPhysicianMedical Necessity; Unsatisfactory Settle/OfferYesAdditional Monies Received; Contract Language/Legal Issue2012-07-19T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured3032Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2911BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received2012-07-19T00:00:002012-09-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG2912AETNA LIFE INSURANCE COMPANYProviderDenial Of Claim; Unsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-07-23T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORGBUNDLING2913HUMANA INSURANCE COMPANYProviderDenial Of Claim; Unsatisfactory Settle/OfferYesContract Language/Legal Issue; Claim Not Clean; Additional Monies Received2012-07-23T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORG2914PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld2012-07-23T00:00:002012-10-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING2915AMERICAN BANKERS LIFE ASSURANCE COMPANY OF FLORIDAInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-07-30T00:00:002012-09-28T00:00:00Life, Accident and HealthAccident and HealthCredit DisabilityGR Elected Official177Ins Co - Licensed/ActiveOrganizationINDV2916STATE NATIONAL INSURANCE COMPANY, INC.Consumer (Non-Insured)OtherNoCompany Position Upheld2012-07-23T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass3242Ins Co - Licensed/ActiveOrganizationINDV2917BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredIdentification Card IssueNoCorrective Action Taken; No Jurisdiction; Information Furnished2012-08-01T00:00:002012-08-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HGR Elected Official10047Ins Co - Licensed/ActiveOrganizationINDV2918STATE FARM LLOYDSConsumer (Non-Insured)Cancellation; Premium and RatingNoCorrective Action Taken2012-07-23T00:00:002012-10-29T00:00:00Property and CasualtyHomeownersHomeowners Group3105Ins Co - Licensed/ActiveOrganizationINDV2919ONEBEACON AMERICA INSURANCE COMPANYEmployerDelays (Claims Handling)NoInformation Furnished2012-08-01T00:00:002012-09-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2828Ins Co - Licensed/ActiveOrganizationORG2920HOCHHEIM PRAIRIE CASUALTY INSURANCE COMPANYThird PartyDenial Of ClaimNoQuestion of Fact; Information Furnished; Additional Monies Received2012-07-19T00:00:002013-02-28T00:00:00Property and CasualtyHomeownersHomeowners1152Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2921SAFECO INSURANCE COMPANY OF INDIANAInsuredNon-RenewalNoCompany Position Upheld2012-07-23T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeowners2496Ins Co - Licensed/ActiveOrganizationINDV2922TRINITY UNIVERSAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-07-19T00:00:002012-09-18T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1353Ins Co - Licensed/ActiveOrganizationINDVDIMINISHED VALUE; GR-Claim Evaluation2923MGA INSURANCE COMPANY, INC.InsuredEndorsement / RiderNoCompany Position Upheld2012-07-23T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass812Ins Co - Licensed/ActiveOrganizationINDVPOLICY EXCLUSION2924Marathon Petroleum CoInsuredOtherNoNo Jurisdiction2012-07-23T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company67644EmployerOrganizationINDV2925STANDARD INSURANCE COMPANYInsuredRecoupment Of Claims Payment; Unsatisfactory Settle/OfferNoInformation Furnished2012-07-23T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&H582Ins Co - Licensed/ActiveOrganizationINDV2926COMMUNITY FIRST HEALTH PLANS, INC.InsuredDelays (Claims Handling)NoNo Jurisdiction; Information Furnished2012-07-23T00:00:002012-09-20T00:00:00Health Maintenance OrgAccident and HealthGroup A&H12210Health Maintenance OrgOrganizationINDVPRESCRIPTION2927STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredCancellation; Non-RenewalNoInformation Furnished2012-07-23T00:00:002012-10-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV2929UNITEDHEALTHCARE INSURANCE COMPANYProviderRecoupment Of Claims PaymentYesInformation Furnished2012-07-23T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation2930GEOVERA SPECIALTY INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received2012-07-23T00:00:002012-10-29T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent56985Ins Co - Surplus LinesOrganizationINDV2931IMPERIAL FIRE AND CASUALTY INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferYesAdditional Monies Received; Claim Settled2012-07-19T00:00:002012-11-09T00:00:00Property and CasualtyHomeownersHomeowners8486Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; OVERHEAD AND PROFIT; SUPPLEMENTARY PAYMENT2932SAFEGUARD HEALTH ENTERPRISES, INC.InsuredDelays (Claims Handling)YesInformation Furnished2012-07-23T00:00:002012-09-28T00:00:00Health Maintenance OrgAccident and HealthGroup A&H51482Ins Co - Licensed/ActiveOrganizationINDV2933INDEPENDENT ORDER OF FORESTERS, THEAgentAgent/Agency Contrct TerminYesInformation Furnished2012-07-23T00:00:002012-11-13T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life13242Ins Co - Licensed/ActiveOrganizationINDV2934ASI LLOYDSInsuredDelays (Claims Handling)YesClaim Settled; Additional Monies Received2012-07-23T00:00:002012-10-03T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent14728Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING2935USAA CASUALTY INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoQuestion of Fact2012-07-19T00:00:002012-09-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass3607Ins Co - Licensed/ActiveOrganizationINDVDIMINISHED VALUE; GR-Claim Evaluation2936LOYA INSURANCE COMPANYProviderAssignment of BenefitsNoInformation Furnished2012-07-19T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured15643Ins Co - Licensed/ActiveOrganizationORGCHIROPRACTIC2937ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredRefund Of PremiumNoCompany Position Upheld; Information Furnished2012-07-23T00:00:002012-10-11T00:00:00Property and CasualtyHomeownersHomeowners936Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA2938SUPERIOR HEALTHPLAN, INC.RelativeRefusal to InsureNoInformation Furnished; No Jurisdiction2012-07-23T00:00:002012-10-11T00:00:00Children Health Insurance PlanAccident and HealthIndividual A & HAssociated Subject Company; Insured10198Health Maintenance OrgOrganizationINDV2941PLATTE RIVER INSURANCE COMPANYInsuredInsurer FraudNoContract Language/Legal Issue; Question of Fact2012-07-19T00:00:002012-09-18T00:00:00Property and CasualtyMiscellaneousFidelity & SuretyInsured Company674Ins Co - Licensed/ActiveOrganizationINDV2942UNION INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-07-23T00:00:002012-10-10T00:00:00Property and CasualtyLiabilityGeneral Liability1321Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2943CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-20T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationINDV2944COMMUNITY FIRST HEALTH PLANS, INC.InsuredCoordination of Benefits; Delays (Claims Handling)NoInformation Furnished; Contract Language/Legal Issue2012-07-23T00:00:002012-09-20T00:00:00Health Maintenance OrgAccident and HealthGroup A&H12210Health Maintenance OrgOrganizationINDVCOVERAGE DISPUTE2945HUMANA INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-23T00:00:002012-10-13T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1040Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN2946MGA INSURANCE COMPANY, INC.Third PartyCust Service Claim Handling; Delays (Claims Handling)YesAdditional Monies Received; Claim Settled2012-07-23T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileIndividual Private Pass812Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING2947ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished2012-07-23T00:00:002012-10-04T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDV2948ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling)YesClaim Settled2012-07-23T00:00:002012-12-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING2949BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDeclination Of Verification; Denial Of ClaimNoNo Jurisdiction2012-07-23T00:00:002012-09-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationINDV2950TEXAS MUTUAL INSURANCE COMPANYNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-07-16T00:00:002012-10-22T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkCorrespondent Person; Insured3500Ins Co - Licensed/ActiveOrganizationORG2950TEXAS STAR NETWORK/COVENTRYNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-07-16T00:00:002012-10-22T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkCorrespondent Person; Insured55311WC Healthcare Provider NtwkOrganizationORG2951OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Additional Payment Expected2012-07-23T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDV2952COMBINED INSURANCE COMPANY OF AMERICAInsuredDenial Of ClaimNoCompany Position Upheld2012-07-24T00:00:002012-10-22T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2863Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2953SOUTHERN VANGUARD INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-07-23T00:00:002012-12-05T00:00:00Property and CasualtyHomeownersHomeowners9429Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2954GERMANIA FARM MUTUAL INSURANCE ASSOCIATIONInsuredDenial Of Claim; Non-RenewalNoCompany Position Upheld; Contract Language/Legal Issue2012-07-23T00:00:002012-10-27T00:00:00Property and CasualtyHomeownersHomeowners2468Ins Co - Licensed/ActiveOrganizationINDV2012 NORTH TEXAS TORNADOES; DEDUCTIBLE; ROOF2956SOUTHERN COUNTY MUTUAL INSURANCE COMPANYInsuredEndorsement / Rider; Unsatisfactory Settle/OfferNoCompany Position Upheld; Additional Payment Expected2012-07-23T00:00:002012-10-29T00:00:00Property and CasualtyHomeownersMobile Homeowner1583Ins Co - Licensed/ActiveOrganizationINDVDEPRECIATION; GR-Claim Evaluation; HAIL2957GEICO GENERAL INSURANCE COMPANYConsumer (Non-Insured)Unsatisfactory Settle/OfferNoQuestion of Fact2012-07-23T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company2684Ins Co - Licensed/ActiveOrganizationORG2958TEXAS HEALTHCARE FOUNDATION, L.P.InsuredDelays (Claims Handling)NoNo Jurisdiction; Information Furnished2012-07-23T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&H51103Third Party AdministratorsOrganizationINDV2959HOME STATE COUNTY MUTUAL INSURANCE COMPANYConsumer (Non-Insured)Delays (Claims Handling)NoAdditional Payment Expected2012-07-23T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency2362Ins Co - Licensed/ActiveOrganizationINDVREPLACEMENT VEHICLE2961AMERICAN ACCESS CASUALTY COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished2012-07-23T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company30332Ins Co - Licensed/ActiveOrganizationORG2962VALLEY BAPTIST INSURANCE COMPANYProviderDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-07-20T00:00:002012-09-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured24403Ins Co - Licensed/ActiveOrganizationORG2963JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.)InsuredPremium and RatingNoInformation Furnished; Contract Language/Legal Issue2012-07-24T00:00:002012-09-06T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1148Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN2964HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredCancellationNoInformation Furnished; Contract Language/Legal Issue2012-07-23T00:00:002012-10-04T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency2362Ins Co - Licensed/ActiveOrganizationINDV2965LIBERTY LIFE ASSURANCE COMPANY OF BOSTONInsuredDelays (Claims Handling)NoNo Jurisdiction2012-07-21T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2205Ins Co - Licensed/ActiveOrganizationINDV2966METROPOLITAN LLOYDS INSURANCE COMPANY OF TEXASThird PartyDelays (Claims Handling)NoClaim Settled; Information Furnished2012-07-24T00:00:002012-09-21T00:00:00Property and CasualtyAutomobileIndividual Private PassCorrespondent Person; Insured3848Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; CHIROPRACTIC2967ALLSTATE INSURANCE COMPANYThird PartyDelays (Claims Handling); Liability DisputeNoInformation Furnished2012-07-23T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileIndividual Private Pass168Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2967GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyDelays (Claims Handling); Liability DisputeYesAdditional Payment Expected; Information Furnished2012-07-23T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2968AMERICAN MEDICAL AND LIFE INSURANCE COMPANYInsuredPre-Existing Condition; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-24T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H74Ins Co - Licensed/ActiveOrganizationINDV2969OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-07-23T00:00:002012-10-09T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2970STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredOtherNoInformation Furnished2012-07-23T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person1510Ins Co - Licensed/ActiveOrganizationINDV2971HALLMARK SPECIALTY UNDERWRITERS, INC.AgentDelays (Policyholder Service); Refund Of PremiumYesPremium Refunded; Information Furnished2012-07-23T00:00:002012-12-19T00:00:00Property and CasualtyAutomobileBusiness Automobile4870Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA2971DELTA GENERAL AGENCY CORPORATIONAgentDelays (Policyholder Service)NoInformation Furnished; Additional Payment Expected2012-07-23T00:00:002012-12-19T00:00:00Property and CasualtyAutomobileBusiness Automobile4938Insurance AgencyOrganizationINDVUNDERWRITING CRITERIA2972GEICO GENERAL INSURANCE COMPANYConsumer (Non-Insured)Unsatisfactory Settle/OfferNoQuestion of Fact2012-07-23T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2684Ins Co - Surplus LinesOrganizationORG2973OAK BROOK COUNTY MUTUAL INSURANCE COMPANYProviderAssignment of BenefitsNoInformation Furnished2012-07-18T00:00:002012-09-07T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person2323Ins Co - Licensed/ActiveOrganizationORG2974OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDenial Of ClaimNoContract Language/Legal Issue; Company Position Upheld2012-07-24T00:00:002012-09-14T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Associated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED2975GEICO GENERAL INSURANCE COMPANYConsumer (Non-Insured)Unsatisfactory Settle/OfferNoQuestion of Fact2012-07-23T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass2684Ins Co - Licensed/ActiveOrganizationORG2976SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.ProviderMedical Necessity; Unsatisfactory Settle/OfferNoInformation Furnished2012-07-18T00:00:002012-10-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured1203Ins Co - Licensed/ActiveOrganizationORG2978METROPOLITAN LLOYDS INSURANCE COMPANY OF TEXASInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferYesInformation Furnished; Claim Settled2012-07-23T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company3848Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING2979METROPOLITAN LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoAdditional Monies Received; Information Furnished2012-07-23T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H13191Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE2980ALAMO TITLE INSURANCEInsuredDenial Of ClaimNoCompany Position Upheld2012-07-23T00:00:002012-08-28T00:00:00Property and CasualtyMiscellaneousTitle Insurance51821Ins Co - Licensed/ActiveOrganizationINDV2981BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished; Claim Not Clean2012-07-23T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG2982BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONHospitalPrompt Pay; SB418 Rule ViolationYesClaim Not Clean; Clean Claims Violation; Information Furnished2012-07-23T00:00:002012-09-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation2983OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYAttorneyCust Service Claim Handling; Delays (Claims Handling)NoAdditional Payment Expected; Information Furnished2012-07-23T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Person; Insured; Third Party Admin-Non Licensed1823Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; TOTAL LOSS2986TRUCK INSURANCE EXCHANGEInsuredDelays (Claims Handling)NoQuestion of Fact2012-07-23T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileBusiness Automobile1355Ins Co - Licensed/ActiveOrganizationORG2988STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredDelays (Claims Handling); Liability Dispute; Unsatisfactory Settle/OfferYesInformation Furnished2012-07-19T00:00:002012-10-02T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV2989AETNA LIFE INSURANCE COMPANYInsuredBalance BillingNoInsufficient Information2012-07-23T00:00:002012-09-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDVEMERGENCY CARE2991SENTINEL INSURANCE COMPANY, LTD.InsuredDenial Of ClaimNoInformation Furnished; Additional Payment Expected; Contract Language/Legal Issue2012-07-23T00:00:002012-10-05T00:00:00Property and CasualtyFire, Allied Lines & CMPBusiness Owners11174Ins Co - Licensed/ActiveOrganizationORG2992PRUDENTIAL INSURANCE COMPANY OF AMERICA, THEInsuredPremium NoticeNoRate Problem Resolved2012-07-24T00:00:002012-09-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1729Ins Co - Licensed/ActiveOrganizationINDV2993BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONHospitalDenial Of Pymt For Emerg Care; Medical Necessity; Unsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-07-20T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGEMERGENCY CARE; GR-Claim Evaluation2995INDEPENDENT ORDER OF FORESTERS, THEInsuredOtherNoInformation Furnished; Premium Refunded2012-07-20T00:00:002012-11-16T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H13242Ins Co - Licensed/ActiveOrganizationINDV2996UNITEDHEALTHCARE INSURANCE COMPANYInsuredCust Service Claim Handling; OtherNoNo Jurisdiction2012-07-20T00:00:002012-09-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation2997AMERICAN INCOME LIFE INSURANCE COMPANYRelativeRefund Of PremiumNoCancel/Non-Renewal Upheld2012-07-20T00:00:002012-10-18T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life109Ins Co - Licensed/ActiveOrganizationINDV2998CIGNA HEALTHCARE OF TEXAS, INC.RelativeDenial Of ClaimNoNo Jurisdiction2012-07-20T00:00:002012-11-28T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Person; Insured8294Self-Funded / ErisaOrganizationINDV2998Assurant HealthRelativeDenial Of ClaimNoNo Jurisdiction2012-07-20T00:00:002012-11-28T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Person; Insured68288Third Party AdministratorsOrganizationINDV2999FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredBalance Billing; Delays (Policyholder Service)NoCompany Position Upheld2012-07-19T00:00:002012-10-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDV2999FARMERS INSURANCE EXCHANGEInsuredOtherNo2012-07-19T00:00:002012-10-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass2668Ins Co - Licensed/ActiveOrganizationINDV3000AETNA LIFE INSURANCE COMPANYPhysicianDelays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-07-20T00:00:002012-09-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDV3001HARTFORD LIFE INSURANCE COMPANYInsuredCash ValueNoContract Language/Legal Issue; Information Furnished2012-07-20T00:00:002012-10-19T00:00:00Life, Accident and HealthLife & AnnuityGroup Annuities1119Ins Co - Licensed/ActiveOrganizationINDV3002GERMANIA FIRE & CASUALTY COMPANYThird PartyDenial Of Claim; Liability DisputeNoCompany Position Upheld; Information Furnished; Question of Fact2012-07-23T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured3298Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; TOTAL LOSS3002TEXAS FARM BUREAU CASUALTY INSURANCE COMPANYThird PartyDenial Of ClaimNoQuestion of Fact; Company Position Upheld; Information Furnished2012-07-23T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured28440Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; TOTAL LOSS3003TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredRefund Of PremiumNoInformation Furnished2012-07-19T00:00:002012-11-05T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company1444Ins Co - Licensed/ActiveOrganizationINDV3003CONNECT INSURANCE AGENCY, INC.InsuredAgent Handling; ConversionYesInformation Furnished2012-07-19T00:00:002012-11-05T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company29654AgentOrganizationINDV3003GARCIA, MONICA LIZETTEInsuredAgent Handling; ConversionYesReferred for Disciplinary Actn; Premium Refunded; Additional Payment Expected2012-07-19T00:00:002012-11-05T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company335086AgentIndividualINDV3004GLOBE LIFE AND ACCIDENT INSURANCE COMPANYInsuredCancellationNoInformation Furnished2012-07-20T00:00:002012-10-01T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life917Ins Co - Licensed/ActiveOrganizationINDV3005HOME STATE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld2012-07-23T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private Pass2362Ins Co - Licensed/ActiveOrganizationINDV3006LIFE INSURANCE COMPANY OF THE SOUTHWESTInsuredAgent Handling; MisrepresentationNoNo Jurisdiction2012-08-01T00:00:002012-10-02T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2158Ins Co - Licensed/ActiveOrganizationINDV3006Bacsik, Robert DInsuredMisrepresentationNo2012-08-01T00:00:002012-10-02T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1154190AgentIndividualINDV3007COLONIAL COUNTY MUTUAL INSURANCE COMPANYAttorneyDelays (Claims Handling)YesInformation Furnished; Additional Monies Received; Additional Payment Expected2012-07-23T00:00:002012-10-18T00:00:00Property and CasualtyAutomobileIndividual Private PassCorrespondent Person; Insured2455Ins Co - Licensed/ActiveOrganizationORG3008OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)YesClaim Settled2012-07-23T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; LOSS OF USE3009HUMANA INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-07-20T00:00:002012-09-06T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1040Ins Co - Licensed/ActiveOrganizationORG3010U S LLOYDS INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished2012-07-23T00:00:002012-10-19T00:00:00Property and CasualtyHomeownersHomeowners3177Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF3011GEICO GENERAL INSURANCE COMPANYConsumer (Non-Insured)Unsatisfactory Settle/OfferNoQuestion of Fact2012-07-23T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass2684Ins Co - Licensed/ActiveOrganizationORG3012GRAMERCY INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished2012-07-23T00:00:002012-10-02T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured; Third Party Admin-Licensed1062Ins Co - Licensed/ActiveOrganizationINDVLOSS OF USE; TOTAL LOSS3013BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction2012-07-20T00:00:002012-09-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured10047Ins Co - Licensed/ActiveOrganizationORG3014BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoClaim Settled2012-07-17T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV3015STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoAdditional Monies Received; Claim Settled2012-07-23T00:00:002012-09-14T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVDIMINISHED VALUE; GR-Claim Evaluation3017OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDenial Of Claim; OtherNoInformation Furnished2011-09-27T00:00:002013-03-14T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDV3018UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-20T00:00:002012-09-13T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company; Insured1348Ins Co - Licensed/ActiveOrganizationORG3019SENTINEL INSURANCE COMPANY, LTD.InsuredDelays (Claims Handling)NoCompany Position Upheld2012-07-20T00:00:002012-09-28T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied LinesAssociated Subject Company11174Ins Co - Licensed/ActiveOrganizationINDVLOSS OF USE3020Comfort Dental Gold PlanInsuredMisrepresentation; Other; Premium NoticeYesFailure to Timely Respond2012-07-27T00:00:002012-11-26T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H76272OtherOrganizationINDV3021CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDenial Of Claim; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-23T00:00:002012-09-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3022AMERICAN GENERAL LIFE INSURANCE COMPANYRelativeDelays (Policyholder Service)NoNo Jurisdiction2012-07-30T00:00:002012-08-22T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured152Ins Co - Licensed/ActiveOrganizationINDV3025ALLSTATE INDEMNITY COMPANYThird PartyDenial Of ClaimNoQuestion of Fact; Information Furnished; Company Position Upheld2012-07-22T00:00:002012-09-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass167Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DIMINISHED VALUE3029ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYConsumer (Non-Insured)Delays (Claims Handling); Denial Of ClaimNoInformation Furnished; Company Position Upheld2012-07-31T00:00:002012-09-20T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured936Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; LOSS OF USE; SUPPLEMENTARY PAYMENT3030HUMANA INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-23T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Self-Funded / ErisaOrganizationORG3031HUMANA INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Additional Monies Received2012-07-23T00:00:002012-09-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2877Ins Co - Licensed/ActiveOrganizationORG3032TEXAS FARM BUREAU UNDERWRITERSInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld2012-07-27T00:00:002013-05-24T00:00:00Property and CasualtyHomeownersHomeowners1451Ins Co - Licensed/ActiveOrganizationINDV3033AETNA LIFE INSURANCE COMPANYProviderDenial Of Claim; Medical NecessityNoNo Jurisdiction; Additional Monies Received2012-06-27T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3034HUMANA HEALTH PLAN OF TEXAS, INC.ProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-23T00:00:002012-10-22T00:00:00Health Maintenance OrgAccident and HealthIndividual A & HInsured702Health Maintenance OrgOrganizationORG3035OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYConsumer (Non-Insured)Cust Service Claim Handling; Delays (Claims Handling)NoRecord Only2012-07-31T00:00:002012-11-28T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVREPLACEMENT VEHICLE; SUPPLEMENTARY PAYMENT3036HUMANA HEALTH PLAN, INC.ProviderUnsatisfactory Settle/OfferYesAdditional Monies Received; No Jurisdiction2012-07-23T00:00:002012-10-16T00:00:00Health Maintenance OrgAccident and HealthIndividual A & HInsured53598Health Maintenance OrgOrganizationORG3037HUMANA HEALTH PLAN OF TEXAS, INC.ProviderUnsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received; No Jurisdiction2012-07-23T00:00:002012-09-24T00:00:00Medicare HMOAccident and HealthGroup A&HAssociated Subject Company; Correspondent Person; Insured702Ins Co - Licensed/ActiveOrganizationORG3039HUMANA HEALTH PLAN OF TEXAS, INC.ProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Additional Monies Received; Information Furnished2012-07-23T00:00:002012-08-29T00:00:00Medicare HMOAccident and HealthGroup A&HCorrespondent Person; Insured702Health Maintenance OrgOrganizationORGSENIOR CITIZEN3040HUMANA HEALTH PLAN, INC.ProviderDenial Of ClaimYesAdditional Monies Received2012-07-23T00:00:002012-10-16T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured53598Health Maintenance OrgOrganizationORG3041STONEBRIDGE LIFE INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished2012-07-24T00:00:002012-10-22T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured2269Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3042STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoClaim Settled2012-07-22T00:00:002012-11-01T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV3042OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoClaim Settled2012-07-22T00:00:002012-11-01T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDV3043BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONPhysicianDenial Of ClaimNoInformation Furnished; No Jurisdiction2012-07-23T00:00:002012-09-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV3045Humana Insurance CompanyProviderDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-07-23T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured35869Ins Co - Licensed/ActiveOrganizationORG3046HUMANA HEALTH PLAN OF TEXAS, INC.ProviderDenial Of Claim; Medical Necessity; Unsatisfactory Settle/OfferNoAdditional Monies Received; No Jurisdiction2012-07-23T00:00:002012-10-03T00:00:00Medicare HMOAccident and HealthIndividual A & HCorrespondent Company; Insured702Health Maintenance OrgOrganizationORGSENIOR CITIZEN3047GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyDenial Of ClaimYesInformation Furnished; Additional Payment Expected2012-07-24T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDV3048HUMANA INSURANCE COMPANYProviderDelays (Claims Handling)YesContract Language/Legal Issue; Corrective Action Taken; Information Furnished2012-07-23T00:00:002012-11-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Correspondent Person; Insured1040Ins Co - Licensed/ActiveOrganizationORG3050COMPANION PROPERTY AND CASUALTY INSURANCE COMPANYInsuredDelays (Policyholder Service); Refund Of PremiumNoInformation Furnished; Premium Refunded2012-07-24T00:00:002012-09-26T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency10484Ins Co - Licensed/ActiveOrganizationINDV3051HUMANA HEALTH PLAN OF TEXAS, INC.ProviderDenial Of Claim; Medical Necessity; Unsatisfactory Settle/OfferNoNo Jurisdiction; Additional Monies Received2012-07-23T00:00:002012-10-03T00:00:00Medicare HMOAccident and HealthIndividual A & HCorrespondent Company; Insured702Health Maintenance OrgOrganizationORGSENIOR CITIZEN3052BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-07-23T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV3053HUMANA HEALTH PLAN OF TEXAS, INC.OtherDenial Of ClaimNoNo Jurisdiction2012-07-23T00:00:002012-10-22T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HCorrespondent Company; Insured702Health Maintenance OrgOrganizationORGBUNDLING; CANCER; GR-Claim Evaluation3054UNITEDHEALTHCARE INSURANCE COMPANYPhysicianRecoupment Of Claims PaymentYesClaim Settled2012-07-23T00:00:002012-10-27T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1348Ins Co - Licensed/ActiveOrganizationINDV3055FIRE INSURANCE EXCHANGEInsuredDenial Of ClaimNoCompany Position Upheld; Information Furnished2012-07-24T00:00:002012-09-21T00:00:00Property and CasualtyHomeownersHomeowners2606Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; ROOF; WATER DAMAGE3056DENTICARE, INC.InsuredDenial Of ClaimYesInformation Furnished; Additional Monies Received2012-07-23T00:00:002012-09-04T00:00:00Health Maintenance OrgAccident and HealthGroup A&HAssociated Subject Company; Correspondent Person3712Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation3057UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of Claim; Medical Necessity; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-23T00:00:002012-09-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3058GERMAN-AMERICAN FARM MUTUALInsuredCust Service Claim Handling; Denial Of ClaimNoQuestion of Fact; Contract Language/Legal Issue2012-04-19T00:00:002013-08-02T00:00:00Property and CasualtyHomeownersHomeowners2467Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; ROOF3059CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderRecoupment Of Claims PaymentNoInformation Furnished; No Jurisdiction2012-07-23T00:00:002012-09-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured2851Ins Co - Licensed/ActiveOrganizationORG3060TEXAS HEALTH INSURANCE POOLRelativeUnsatisfactory Settle/OfferNoInformation Furnished2012-07-23T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured9031Ins Co - Licensed/ActiveOrganizationINDV3062STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXASThird PartyUnsatisfactory Settle/OfferNoQuestion of Fact; Additional Monies Received2012-07-20T00:00:002012-09-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass1506Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3064ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoClaim Settled; Company Position Upheld2012-07-12T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation3065NATIONAL FARM LIFE INSURANCE COMPANYBeneficiaryRefund Of Premium; Unsatisfactory Settle/OfferNoPremium Refunded2012-07-23T00:00:002012-11-15T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured1944Ins Co - Licensed/ActiveOrganizationINDV3066ALLSTATE INDEMNITY COMPANYThird PartyUnsatisfactory Settle/OfferYesInformation Furnished2012-07-24T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass167Ins Co - Licensed/ActiveOrganizationINDV3067BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderRecoupment Of Claims Payment; SB418 Rule ViolationYesContract Language/Legal Issue; Overpaid Claim Recouped; Clean Claims Violation2012-07-23T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGMULTIPLE INSUREDS3068BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderLifetime/Annual Limits; Usual And CustomaryNoContract Language/Legal Issue; Company Position Upheld2012-07-23T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGEMERGENCY CARE; GR-Claim Evaluation3069CELTIC INSURANCE COMPANYProviderDenial Of ClaimNoAdditional Monies Received; Corrective Action Taken2012-07-23T00:00:002013-02-15T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured93Ins Co - Licensed/ActiveOrganizationINDV3070HORACE MANN PROPERTY & CASUALTY INSURANCE COMPANYInsuredDelays (Claims Handling)NoClaim Settled; Information Furnished2012-07-24T00:00:002012-09-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass1734Ins Co - Licensed/ActiveOrganizationINDV3070TSAN, SAN SANInsuredAgent HandlingNoInformation Furnished2012-07-24T00:00:002012-09-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass520745AgentIndividualINDV3071STARR INDEMNITY & LIABILITY COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue2012-07-23T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H997Ins Co - Licensed/ActiveOrganizationINDV3072AETNA LIFE INSURANCE COMPANYProviderRecoupment Of Claims PaymentNoNo Jurisdiction2012-07-23T00:00:002012-08-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG3073BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferYesContract Language/Legal Issue; Information Furnished; Additional Monies Received2012-07-23T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG3076AMERICAN GENERAL LIFE INSURANCE COMPANYAgentDelays (Policyholder Service)NoInformation Furnished; Policy Not In Force2012-07-23T00:00:002012-11-16T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Person; Insured152Ins Co - Licensed/ActiveOrganizationINDV3078Blue Cross and Blue Shield of KansasInsuredUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-07-25T00:00:002012-10-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured Company75596OtherOrganizationINDVGR-Claim Evaluation3079BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONRelativePremium and RatingNoInformation Furnished2012-07-25T00:00:002012-09-17T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured10047Ins Co - Licensed/ActiveOrganizationINDV3080AMERICAN GENERAL LIFE INSURANCE COMPANYInsuredCash Value; Refund Of PremiumNoInformation Furnished; Contract Language/Legal Issue2012-07-25T00:00:002012-10-11T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life152Ins Co - Licensed/ActiveOrganizationINDV3082TRUE BENEFITS ADMINISTRATORSInsuredDenial Of ClaimNoClaim Settled; Contract Language/Legal Issue2012-07-25T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company67456Self-Funded / ErisaOrganizationINDV3083RELIASTAR LIFE INSURANCE COMPANYInsuredPremium and RatingNoContract Language/Legal Issue2012-07-23T00:00:002012-11-13T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1863Ins Co - Licensed/ActiveOrganizationINDV3084STATE FARM LLOYDSOtherUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-07-24T00:00:002012-10-05T00:00:00Property and CasualtyHomeownersHomeownersInsured3105Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; OVERHEAD AND PROFIT3086PRUDENTIAL INSURANCE COMPANY OF AMERICA, THEInsuredPremium and RatingNoContract Language/Legal Issue2012-07-25T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1729Ins Co - Licensed/ActiveOrganizationINDV3088BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoNo Jurisdiction2012-07-25T00:00:002012-09-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV3089CONNECTICUT GENERAL LIFE INSURANCE COMPANYRelativeUnsatisfactory Settle/OfferNoOther2012-07-25T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationINDV3090COMPREHENSIVE BEHAVIORAL CARE, INC.ProviderDelays (Claims Handling)NoContract Language/Legal Issue; Insufficient Information2012-07-31T00:00:002012-11-06T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured44120Ins Co - Licensed/ActiveOrganizationORG3091HUMANA INSURANCE COMPANYProviderDenial Of ClaimNoContract Language/Legal Issue2012-07-23T00:00:002012-11-09T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1040Ins Co - Licensed/ActiveOrganizationORG3092DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling)NoQuestion of Fact2012-07-23T00:00:002012-10-01T00:00:00Property and CasualtyAutomobileIndividual Private Pass2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation3093GOLDEN RULE INSURANCE COMPANYInsuredRefund Of PremiumNoInformation Furnished2012-07-25T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1057Ins Co - Licensed/ActiveOrganizationINDVFEDERAL HEALTH CARE REFORM3094INSURANCE MANAGEMENT ADMINSTRATORS, INC.ProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Insufficient Information2012-07-25T00:00:002013-01-08T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company25617Self-Funded / ErisaOrganizationORG3095CAREMARK, L.L.C.ProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-24T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured56496Third Party AdministratorsOrganizationORGPHARMACY; PRESCRIPTION3096AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-23T00:00:002012-09-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationORG3097ALLSTATE INSURANCE COMPANYConsumer (Non-Insured)Agent HandlingNoInformation Furnished2012-07-24T00:00:002012-10-03T00:00:00Property and CasualtyHomeownersHomeowners168Ins Co - Licensed/ActiveOrganizationINDVCREDIT REPORT3097LONGACRE, RICHARD WILLIAMConsumer (Non-Insured)Agent HandlingNoInformation Furnished2012-07-24T00:00:002012-10-03T00:00:00Property and CasualtyHomeownersHomeowners692541AgentIndividualINDVCREDIT REPORT3098AMERICAN INCOME LIFE INSURANCE COMPANYInsuredRefund Of PremiumYesPremium Refunded2012-07-25T00:00:002012-11-16T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life109Ins Co - Licensed/ActiveOrganizationINDV3100HUMANA INSURANCE COMPANYProviderRecoupment Of Claims Payment; Unsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-07-24T00:00:002012-11-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured1040Health Maintenance OrgOrganizationORGGR-Claim Evaluation3101LIFE INSURANCE COMPANY OF THE SOUTHWESTInsuredDelays (Policyholder Service)NoInformation Furnished2012-07-25T00:00:002012-10-24T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities2158Ins Co - Licensed/ActiveOrganizationINDV3103TIME INSURANCE COMPANYRelativeUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-07-25T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1374Ins Co - Licensed/ActiveOrganizationINDV3103OCHUKO, ANTHONY TOBORERelativeMisrepresentationNoInformation Furnished2012-07-25T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured964110AgentIndividualINDV3104CELTIC INSURANCE COMPANYProviderDenial Of ClaimYesClaim Settled2012-07-23T00:00:002013-02-05T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured93Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3106UNITEDHEALTHCARE OF TEXAS, INC.ProviderDenial Of Claim; Recoupment Of Claims PaymentNoNo Jurisdiction2012-07-24T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured3363Health Maintenance OrgOrganizationORGGR-Claim Evaluation3107GERMAN-AMERICAN FARM MUTUALInsuredDenial Of ClaimYesInformation Furnished; Claim Settled2012-07-24T00:00:002012-09-21T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company2467Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE3109SAFECO INSURANCE COMPANY OF INDIANAThird PartyLiability DisputeYesOther; Information Furnished2012-07-24T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2496Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3110UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-24T00:00:002012-09-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3111AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-23T00:00:002012-09-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG3113HUMANA INSURANCE COMPANYHospitalUnsatisfactory Settle/OfferYesAdvertising Withdrawn/Amended2012-07-24T00:00:002012-11-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured1040Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3116TRAVELERS LLOYDS OF TEXAS INSURANCE COMPANYInsuredDelays (Claims Handling); OtherNoReferred To; Information Furnished2012-07-24T00:00:002012-09-21T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company776Ins Co - Licensed/ActiveOrganizationINDVWATER DAMAGE3118BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished2012-07-24T00:00:002012-08-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG3119GOVERNMENT PERSONNEL MUTUAL LIFE INSURANCE COMPANYBeneficiaryAgent Handling; Cash Value; Cust Service Claim Handling; Delays (Claims Handling); MisrepresentationNoNo Jurisdiction; Information Furnished2012-07-23T00:00:002012-10-10T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeCorrespondent Company; Deceased Person2488Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation3120BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished2012-07-24T00:00:002012-08-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG3121ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYAttorneyUnsatisfactory Settle/OfferNoCompany Position Upheld2012-07-20T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured936Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3123TIME INSURANCE COMPANYInsuredDenial Of ClaimYesInformation Furnished; Additional Monies Received2012-07-24T00:00:002012-09-07T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1374Ins Co - Licensed/ActiveOrganizationINDVACQUIRED BRAIN INJURY312421ST CENTURY CENTENNIAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld2012-07-20T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass771Ins Co - Licensed/ActiveOrganizationINDV3125TRAVELERS LLOYDS OF TEXAS INSURANCE COMPANYInsuredDelays (Claims Handling)NoAdditional Payment Expected2012-07-20T00:00:002012-09-27T00:00:00Property and CasualtyHomeownersHomeowners776Ins Co - Licensed/ActiveOrganizationINDVHAIL; ROOF3126UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of Claim; SB418 Rule Violation; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-25T00:00:002012-11-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Self-Funded / ErisaOrganizationORGGR-Claim Evaluation3128CIGNA HEALTH AND LIFE INSURANCE COMPANYProviderDenial Of Claim; SB418 Rule Violation; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-25T00:00:002012-09-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1841Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3129STATE FARM LLOYDSInsuredNon-RenewalNoInformation Furnished; Cancel/Non-Renewal Upheld2012-07-20T00:00:002012-10-11T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVHAIL; ROOF3130PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished2012-07-20T00:00:002012-10-04T00:00:00Property and CasualtyAutomobileMotorcycle1708Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA3131USAA TEXAS LLOYD'S COMPANYInsuredDelays (Claims Handling)NoAdditional Payment Expected; Question of Fact2012-07-24T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners14630Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation3132CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDenial Of Claim; SB418 Rule Violation; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-25T00:00:002012-09-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3133CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDenial Of ClaimNoClaim Settled2012-07-23T00:00:002012-10-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORG3134STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoCompany Position Upheld2012-07-23T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3135CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDenial Of Claim; SB418 Rule Violation; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-25T00:00:002012-09-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3136DAIRYLAND COUNTY MUTUAL INSURANCE COMPANY OF TEXASThird PartyDelays (Claims Handling)NoAdditional Monies Received2012-07-23T00:00:002012-10-21T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured2737Ins Co - Licensed/ActiveOrganizationINDV3137GOLDEN RULE INSURANCE COMPANYInsuredRefund Of PremiumNoContract Language/Legal Issue; Information Furnished2012-07-25T00:00:002012-09-14T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1057Ins Co - Licensed/ActiveOrganizationINDV3138AUTO CLUB INDEMNITY COMPANYInsuredUnsatisfactory Settle/OfferNoAdditional Monies Received; Contract Language/Legal Issue2012-07-23T00:00:002012-11-13T00:00:00Property and CasualtyHomeownersRentalAssociated Agent8776Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DEDUCTIBLE; DEPRECIATION; GR-Claim Evaluation3138HAROLD, PAULA DOTYInsuredAgent HandlingNoQuestion of Fact2012-07-23T00:00:002012-11-13T00:00:00Property and CasualtyHomeownersRentalAssociated Agent428072AgentIndividualINDVADJUSTER'S HANDLING; DEDUCTIBLE; DEPRECIATION; GR-Claim Evaluation3139MTL INSURANCE COMPANYInsuredCancellation; Delays (Policyholder Service); Premium NoticeNoInformation Furnished; Cancel/Non-Renewal Upheld; Contract Language/Legal Issue2012-07-25T00:00:002012-11-13T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life874Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN3140STATE FARM LLOYDSInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-07-23T00:00:002012-10-15T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent3105Ins Co - Licensed/ActiveOrganizationINDVROOF3141BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoNo Jurisdiction2012-07-25T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Self-Funded / ErisaOrganizationINDV3142CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDenial Of Claim; SB418 Rule Violation; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-25T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3143AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoCompany Position Upheld2012-07-25T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured245Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3144UMR, INC.ProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-25T00:00:002012-08-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured23490Third Party AdministratorsOrganizationORG3145FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Claim Settled2012-07-23T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2623Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; UNCOOPERATIVE INSURED3146Harvard Pilgrim Helath CareProviderDelays (Claims Handling)NoAdditional Monies Received; No Jurisdiction2012-07-25T00:00:002012-10-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured66553Self-Funded / ErisaOrganizationORG3147MOLINA HEALTHCARE OF TEXAS, INC.RelativeDelays (Claims Handling)NoInformation Furnished2012-07-25T00:00:002012-09-05T00:00:00Children Health Insurance PlanLife & AnnuityIndividual LifeInsured23469Health Maintenance OrgOrganizationINDV3148PYRAMID LIFE INSURANCE COMPANY, THEProviderDelays (Claims Handling); Recoupment Of Claims PaymentNoInformation Furnished; No Jurisdiction; Additional Payment Expected2012-07-25T00:00:002012-11-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Correspondent Person; Insured1682Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation; SENIOR CITIZEN3149PRODUCERS AGRICULTURE INSURANCE COMPANYInsuredOtherNoCompany Position Upheld; Referred To; Information Furnished2012-07-23T00:00:002012-10-11T00:00:00Property and CasualtyMiscellaneousFederal Crop3603Ins Co - Licensed/ActiveOrganizationINDV3149JONES & LOWE AGENCY INCInsuredAgent HandlingNoInformation Furnished2012-07-23T00:00:002012-10-11T00:00:00Property and CasualtyMiscellaneousFederal Crop4620AgentOrganizationINDV3150UNITED HEALTHCARE SERVICES, INC.ProviderDenial Of Claim; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-25T00:00:002012-08-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured36825Third Party AdministratorsOrganizationORGBUNDLING; GR-Claim Evaluation3151STARR INDEMNITY & LIABILITY COMPANYPhysicianDelays (Claims Handling)No2012-07-25T00:00:002012-09-28T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured997Ins Co - Licensed/ActiveOrganizationINDV3151CO-ORDINATED BENEFIT PLANS, LLCPhysicianDelays (Claims Handling); Pre-Existing ConditionNoContract Language/Legal Issue; Insufficient Information2012-07-25T00:00:002012-09-28T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured76807Third Party AdministratorsOrganizationINDV3152GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredPremium and RatingNoQuestion of Fact; Information Furnished2012-07-23T00:00:002013-02-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDV3153ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYConsumer (Non-Insured)Use of Credit ReportsNoInformation Furnished2012-07-23T00:00:002012-10-19T00:00:00Property and CasualtyHomeownersHomeowners936Ins Co - Licensed/ActiveOrganizationINDVCREDIT REPORT3154PENN-AMERICA INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-07-23T00:00:002012-10-13T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines56199Ins Co - Surplus LinesOrganizationINDVMOLD; ROOF; WATER DAMAGE3155ENCOMPASS INDEMNITY COMPANYInsuredOtherNoCorrective Action Taken2012-07-23T00:00:002012-10-16T00:00:00Property and CasualtyHomeownersHomeowners15014Ins Co - Licensed/ActiveOrganizationINDV3155PREFERRED PERSONAL INSURANCE AGENCY,LLPInsuredAgent HandlingYesInformation Furnished2012-07-23T00:00:002012-10-16T00:00:00Property and CasualtyHomeownersHomeowners24887AgentOrganizationINDV3156PENNSYLVANIA LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-07-25T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1819Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3157HOME STATE COUNTY MUTUAL INSURANCE COMPANYAttorneyUnsatisfactory Settle/OfferNoQuestion of Fact2012-07-23T00:00:002012-10-10T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured2362Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; GR-Claim Evaluation3158STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received; Information Furnished; Claim Settled2012-07-23T00:00:002012-10-09T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF3159CUNNINGHAM, BILL LConsumer (Non-Insured)OtherNoOther2012-07-23T00:00:002012-10-30T00:00:00Property and CasualtyMiscellaneousP & C Misc53199AgentIndividualINDVADVERTISING3160ALLSTATE INSURANCE COMPANYConsumer (Non-Insured)Use of Credit ReportsNoInformation Furnished2012-07-23T00:00:002012-10-12T00:00:00Property and CasualtyMiscellaneousNo Line Specified168Ins Co - Licensed/ActiveOrganizationINDVCREDIT REPORT3161BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoClaim Settled; Additional Monies Received2012-07-24T00:00:002012-09-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG3162STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredRefund Of PremiumNoAdditional Monies Received; Information Furnished2012-07-23T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV3163UNITED OF OMAHA LIFE INSURANCE COMPANYBeneficiaryDelays (Claims Handling); Employer Fraud; Unsatisfactory Settle/OfferNoContract Language/Legal Issue; Insufficient Information2012-07-25T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityGroup LifeAssociated Subject Company; Deceased Person1281Ins Co - Licensed/ActiveOrganizationINDV3164HARTFORD LLOYD'S INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld; Information Furnished2012-07-23T00:00:002012-10-12T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines1017Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; HAIL; ROOF; WATER DAMAGE3166AFFINION BENEFITS GROUP, LLCRelativeCancellation; Delays (Policyholder Service)NoContract Language/Legal Issue2012-07-23T00:00:002012-10-22T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company; Insured; Insured Company29114Third Party AdministratorsOrganizationINDV3167PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-07-23T00:00:002012-11-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDV3168CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDenial Of Claim; SB418 Rule Violation; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-25T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3169ASI LLOYDSInsuredCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferYesAdditional Monies Received; Claim Settled; Information Furnished2012-07-25T00:00:002012-10-10T00:00:00Property and CasualtyHomeownersHomeowners14728Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; BURDEN OF PROOF; DAMAGE DISPUTE; HAIL; ROOF; SUPPLEMENTARY PAYMENT3170ALLSTATE INDEMNITY COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received; Information Furnished; Claim Settled2012-07-25T00:00:002012-10-09T00:00:00Property and CasualtyAutomobileIndividual Private Pass167Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF3171LIFE INSURANCE COMPANY OF NORTH AMERICAInsuredRecoupment Of Claims Payment; Unsatisfactory Settle/OfferNoContract Language/Legal Issue; No Jurisdiction; Information Furnished2012-07-25T00:00:002012-10-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2157Ins Co - Licensed/ActiveOrganizationINDV3172GEICO INDEMNITY COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished2012-07-25T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private Pass2785Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED3173AMERICAN FAMILY HOME INSURANCE COMPANYInsuredDelays (Claims Handling)NoCompany Position Upheld; Information Furnished2012-07-25T00:00:002012-09-21T00:00:00Property and CasualtyHomeownersRentalAssociated Subject Person27668Ins Co - Licensed/ReceivershipOrganizationINDVADJUSTER'S HANDLING3174BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONRelativeRefund Of PremiumNoAdditional Monies Received2012-07-25T00:00:002012-10-25T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured10047Ins Co - Licensed/ActiveOrganizationINDV3175STATE AUTO PROPERTY & CASUALTY INSURANCE COMPANYThird PartyDenial Of ClaimNoQuestion of Fact; Additional Payment Expected2012-07-23T00:00:002012-08-17T00:00:00Property and CasualtyAutomobileIndividual Private PassGR Elected Official28439Ins Co - Licensed/ActiveOrganizationINDVACV; SENIOR CITIZEN; TOTAL LOSS3176BOON-CHAPMAN BENEFIT ADMINISTRATORS, INC.ProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-25T00:00:002012-10-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured136371Self-Funded / ErisaOrganizationORGGR-Claim Evaluation3177PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld; Additional Monies Received2012-07-25T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileMotorcycle1708Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; SUPPLEMENTARY PAYMENT3178SAFECO INSURANCE COMPANY OF INDIANAInsuredUnsatisfactory Settle/OfferNoQuestion of Fact2012-07-25T00:00:002012-10-04T00:00:00Property and CasualtyHomeownersHomeowners2496Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF3179GREEN TREE INSURANCE AGENCY INCInsuredPremium and Rating; Refund Of PremiumNoInformation Furnished; Premium Refunded2012-07-25T00:00:002012-09-27T00:00:00Property and CasualtyHomeownersHomeowners16696Mortgage LenderOrganizationINDV3180WESTERN GENERAL INSURANCEInsuredOtherNoContract Language/Legal Issue2012-07-25T00:00:002012-11-08T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company25909Ins Co - Licensed/ActiveOrganizationINDV3180HOLLAND, HOWARDInsuredAgent HandlingNoInformation Furnished2012-07-25T00:00:002012-11-08T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company728342AgentIndividualINDV3181AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-25T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG3182USAA CASUALTY INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished; Rate Problem Resolved2012-07-25T00:00:002012-10-05T00:00:00Property and CasualtyAutomobileIndividual Private Pass3607Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA3183GARRISON PROPERTY AND CASUALTY INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling); Denial Of ClaimNoQuestion of Fact; Information Furnished; Contract Language/Legal Issue2012-07-25T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass1697Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF3184GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)NoInformation Furnished; Additional Monies Received; Claim Settled2012-07-25T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL3185OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredCancellation; Denial Of ClaimNoInformation Furnished2012-07-25T00:00:002012-11-14T00:00:00Property and CasualtyAutomobileMotorcycleThird Party Admin-Licensed1823Ins Co - Licensed/ActiveOrganizationINDV3186GEOVERA SPECIALTY INSURANCE COMPANYInsuredOther; Unsatisfactory Settle/OfferYesInformation Furnished; Claim Settled2012-07-25T00:00:002012-09-28T00:00:00Property and CasualtyHomeownersHomeowners56985Ins Co - Surplus LinesOrganizationINDVDAMAGE DISPUTE; DEDUCTIBLE; GR-Claim Evaluation; HAIL; ROOF3187UNITED SERVICES AUTOMOBILE ASSOCIATIONAttorneyUnsatisfactory Settle/OfferNoInformation Furnished; Question of Fact2012-07-25T00:00:002012-09-12T00:00:00Property and CasualtyAutomobileIndividual Private PassCorrespondent Company; Insured1254Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3188ALLSTATE TEXAS LLOYD'SInsuredDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; Company Position Upheld2012-07-25T00:00:002012-10-05T00:00:00Property and CasualtyHomeownersHomeowners3721Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF; COVERAGE DISPUTE; UNDERWRITING CRITERIA3189TEXAS FARM BUREAU UNDERWRITERSInsuredCancellationNoCancel/Non-Renewal Upheld; Information Furnished2012-07-25T00:00:002012-10-12T00:00:00Property and CasualtyHomeownersHomeownersInsured1451Ins Co - Licensed/ActiveOrganizationINDV3189KRENZ, LEZLIE HELLOInsuredAgent HandlingNoInformation Furnished2012-07-25T00:00:002012-10-12T00:00:00Property and CasualtyHomeownersHomeownersInsured537570AgentIndividualINDV3191ACCEPTANCE CASUALTY INSURANCE COMPANYOtherDelays (Claims Handling)NoAdditional Monies Received; Claim Settled2012-07-24T00:00:002012-10-09T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent; Insured8207Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; GR-Claim Evaluation; SUPPLEMENTARY PAYMENT3192AAA TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNo2012-07-25T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2286Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3192METROPOLITAN LLOYDS INSURANCE COMPANY OF TEXASThird PartyDenial Of ClaimNoAdditional Payment Expected; Company Position Upheld2012-07-25T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured3848Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3193COLONIAL COUNTY MUTUAL INSURANCE COMPANYLienholderUnsatisfactory Settle/OfferNoQuestion of Fact2012-07-25T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2455Ins Co - Licensed/ActiveOrganizationORGACV; GR-Claim Evaluation; TOTAL LOSS3194TRINITY UNIVERSAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoCompany Position Upheld2012-07-25T00:00:002012-10-09T00:00:00Property and CasualtyAutomobileIndividual Private Pass1353Ins Co - Licensed/ActiveOrganizationINDV3195DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Additional Payment Expected2012-07-25T00:00:002012-12-10T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation3196ACCC INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeNoClaim Settled; Additional Monies Received; Information Furnished2012-07-25T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured9825Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3197AIM ADMINISTRATORS, LTD.ProviderUnsatisfactory Settle/OfferYesReferred To2012-07-10T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured24472Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3198DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Payment Expected; Information Furnished2012-07-25T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF3199NATIONWIDE GENERAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoCompany Position Upheld; Information Furnished2012-07-25T00:00:002012-09-27T00:00:00Property and CasualtyHomeownersHomeowners1934Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation3201OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling); Liability DisputeNoAdditional Monies Received; Information Furnished2012-07-25T00:00:002012-10-04T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Associated Subject Agency; Third Party Admin-Non Licensed1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING3202AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling); Timely Filing DeficiencyNoNo Jurisdiction2012-07-24T00:00:002012-09-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3203TEXAS STAR NETWORK/COVENTRYNon-Contracted ProviderDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-07-06T00:00:002012-12-06T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Company; Correspondent Person; Injured Employee55311WC Healthcare Provider NtwkOrganizationORG3204HUMANA INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesAdditional Monies Received2012-07-25T00:00:002012-11-05T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured1040Ins Co - Licensed/ActiveOrganizationORGEMERGENCY CARE3205GENERAL AMERICAN LIFE INSURANCE COMPANYInsuredDelays (Policyholder Service)NoContract Language/Legal Issue2012-07-26T00:00:002012-11-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesInsured2502Ins Co - Licensed/ActiveOrganizationINDV3206UNITEDHEALTHCARE INSURANCE COMPANYAgentNon-RenewalNoContract Language/Legal Issue; Company Position Upheld2012-07-25T00:00:002012-10-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured; Insured Company1348Ins Co - Licensed/ActiveOrganizationINDV3208BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received; No Jurisdiction2012-07-25T00:00:002012-10-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company10047Ins Co - Licensed/ActiveOrganizationINDV3209METROPOLITAN LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-25T00:00:002012-09-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured13191Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3210PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)YesInformation Furnished; Additional Monies Received2012-07-24T00:00:002012-09-14T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured1708Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING3211CONTINENTAL INSURANCE COMPANY, THEThird PartyDelays (Claims Handling)NoClaim Settled; Information Furnished2012-07-25T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2820Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING3212FARMERS INSURANCE EXCHANGEInsuredDelays (Claims Handling); Denial Of ClaimNoClaim Settled; Information Furnished2012-07-24T00:00:002012-09-21T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent2668Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF3213STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeNoCompany Position Upheld; Information Furnished; Question of Fact2012-07-24T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; LOSS OF USE; TOTAL LOSS3214STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredDelays (Claims Handling); Liability DisputeNoQuestion of Fact; Contract Language/Legal Issue; Information Furnished2012-07-25T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF3215AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-07-25T00:00:002012-09-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDVMULTIPLE INSUREDS3217PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld; Information Furnished; Contract Language/Legal Issue2012-07-25T00:00:002012-10-05T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1708Ins Co - Licensed/ActiveOrganizationINDV3218CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-25T00:00:002012-09-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationINDV3219LLOYD, KENT ALLENAgentAgent HandlingNoInformation Furnished2012-07-24T00:00:002012-09-28T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines423930AgentIndividualORG3220SENTINEL INSURANCE COMPANY, LTD.InsuredDenial Of ClaimYesAdditional Payment Expected; Information Furnished2012-07-25T00:00:002012-09-28T00:00:00Property and CasualtyFire, Allied Lines & CMPBusiness Owners11174Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; DAMAGE DISPUTE; UNDERWRITING CRITERIA3221LINCOLN BENEFIT LIFE COMPANYInsuredCash ValueNoContract Language/Legal Issue; Information Furnished2012-08-03T00:00:002012-09-28T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesGR Elected Official2168Ins Co - Licensed/ActiveOrganizationINDV3222UNITED SERVICES AUTOMOBILE ASSOCIATIONThird PartyDenial Of ClaimNoQuestion of Fact; Information Furnished2012-07-24T00:00:002012-10-09T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1254Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF3223VOYAGER INSURANCE SERVICES INCConsumer (Non-Insured)Improper InducementsNoInsufficient Information2012-07-13T00:00:002012-09-11T00:00:00Property and CasualtyAutomobileMotorcycle4241Ins Co - Licensed/ActiveOrganizationINDV3225RELIABLE LIFE INSURANCE COMPANY, THEInsuredCash ValueNoInformation Furnished2012-07-24T00:00:002012-09-13T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1704Ins Co - Licensed/ActiveOrganizationINDV3225LINCOLN NATIONAL LIFE INSURANCE COMPANY, THEInsuredCash ValueNoInformation Furnished2012-07-24T00:00:002012-09-13T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2172Ins Co - Licensed/ActiveOrganizationINDV3226OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)YesAdditional Monies Received2012-07-24T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDV3227TEXAS MUTUAL INSURANCE COMPANYNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-07-06T00:00:002012-10-22T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Company; Correspondent Person; Insured3500Ins Co - Licensed/ActiveOrganizationORG3228American Auto ShieldInsuredDenial Of ClaimNoReferred To; Information Furnished2012-07-24T00:00:002012-09-20T00:00:00Property and CasualtyMiscellaneousWarranty Contract67782OtherOrganizationINDVCOVERAGE DISPUTE3229OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYLienholderDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-07-25T00:00:002012-09-21T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Insured1823Ins Co - Licensed/ActiveOrganizationORGBURDEN OF PROOF; UNDERWRITING CRITERIA3230MEADOWBROOK, INC.Consumer (Non-Insured)OtherYesInformation Furnished2012-07-25T00:00:002012-10-24T00:00:00Property and CasualtyMiscellaneousNo Line Specified20591Insurance AgencyOrganizationINDV3231RELIANCE STANDARD LIFE INSURANCE COMPANYInsuredCash Value; Unsatisfactory Settle/OfferYesContract Language/Legal Issue2012-07-25T00:00:002012-09-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1647Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3232MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANYLienholderCust Service Claim HandlingNoNo Jurisdiction2012-07-24T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileBusiness AutomobileAssociated Subject Person157Self-Funded / ErisaOrganizationINDV3233PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished; Additional Monies Received; Claim Settled2012-07-25T00:00:002012-10-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; TOTAL LOSS3234ALLSTATE TEXAS LLOYD'SInsuredDelays (Policyholder Service); Refund Of PremiumYesPremium Refunded2012-07-24T00:00:002012-10-24T00:00:00Property and CasualtyHomeownersRental3721Ins Co - Licensed/ActiveOrganizationINDV3235CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderCust Service Claim Handling; Delays (Claims Handling); Timely Filing DeficiencyNoNo Jurisdiction2012-07-25T00:00:002012-09-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3237USAA GENERAL INDEMNITY COMPANYThird PartyDelays (Claims Handling)NoCompany Position Upheld; Information Furnished2012-07-24T00:00:002012-09-20T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured1276Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING3239OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished; Company Position Upheld; Additional Monies Received2012-07-25T00:00:002012-10-10T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING3240NATIONAL LLOYDS INSURANCE COMPANYInsuredDelays (Claims Handling)NoClaim Settled; Information Furnished; Additional Monies Received2012-07-25T00:00:002012-10-04T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines1914Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; ROOF3241CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderPrompt Pay; Unsatisfactory Settle/OfferNoClaim Settled2012-07-25T00:00:002012-09-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3242SAFECO INSURANCE COMPANY OF INDIANAInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Appraisal Process Invoked; Additional Payment Expected2012-07-24T00:00:002012-09-11T00:00:00Property and CasualtyHomeownersHomeownersInsured2496Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation3243HOMEOWNERS OF AMERICA INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-07-25T00:00:002012-10-13T00:00:00Property and CasualtyHomeownersHomeowners25247Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF3244TEXAS HEALTH INSURANCE POOLInsuredAccess to Care; Cancellation; Refusal to InsureNoInformation Furnished; Cancellation Withdrawn2012-07-25T00:00:002012-10-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&H9031Ins Co - Licensed/ActiveOrganizationINDV3245VAL, DONALDInsuredRefund Of PremiumNoPremium Refunded; Information Furnished2012-07-24T00:00:002012-10-09T00:00:00Life, Accident and HealthLife & AnnuityGroup LifeAssociated Agent; Associated Subject Agency606492AgentIndividualINDV3246LIBERTY COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished; Contract Language/Legal Issue2012-07-25T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileIndividual Private Pass3762Ins Co - Licensed/ActiveOrganizationINDVAFTERMARKET PARTS; LOSS OF USE3247NATIONWIDE PROPERTY AND CASUALTY INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished; Additional Monies Received; Company Position Upheld2012-07-25T00:00:002012-10-10T00:00:00Property and CasualtyHomeownersHomeowners3165Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA3248HANOVER INSURANCE COMPANY, THEInsuredDelays (Claims Handling)NoCompany Position Upheld; Information Furnished2012-07-24T00:00:002012-09-24T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2370Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; TOTAL LOSS3249FIRE INSURANCE EXCHANGEInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-07-25T00:00:002012-11-20T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person2606Ins Co - Licensed/ActiveOrganizationINDVDEPRECIATION; HAIL; ROOF3250STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld; Additional Monies Received2012-07-25T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation3251CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDenial Of Claim; Timely Filing DeficiencyNoNo Jurisdiction2012-07-25T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured2851Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3252ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; Additional Monies Received2012-07-25T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF3254FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoQuestion of Fact; Information Furnished; Contract Language/Legal Issue2012-07-25T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured2623Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF3255OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDenial Of ClaimNoQuestion of Fact; Company Position Upheld; Information Furnished2012-07-25T00:00:002012-09-27T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company1823Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF3258AMICA MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoQuestion of Fact; Information Furnished2012-07-25T00:00:002012-10-05T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured3532Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3261STATE FARM LLOYDSInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld2012-07-25T00:00:002013-03-26T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVROOF3262OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue; Question of Fact2012-07-25T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Company; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF3263ACCC INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling); Denial Of ClaimNoContract Language/Legal Issue; Information Furnished; Question of Fact2012-07-25T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF3264MARKEL INTERNATIONAL INSURANCE COMPANY LIMITEDInsuredDelays (Claims Handling)NoContract Language/Legal Issue; Claim Settled2012-07-25T00:00:002012-11-07T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent55933Ins Co - Surplus LinesOrganizationINDV3264FRANKO, VERNON CHARLESInsuredDelays (Policyholder Service); Refund Of PremiumNoPremium Refunded2012-07-25T00:00:002012-11-07T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent231923AgentIndividualINDV3266SUPERIOR ABSTRACT AND TITLE, LLCAttorneyUnauthorized ActsNoCompany Position Upheld2012-07-25T00:00:002012-08-31T00:00:00Property and CasualtyMiscellaneousTitle Insurance66903AgentOrganizationORG3268HUMANA INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction2012-07-26T00:00:002012-11-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationINDV3269LIBERTY COUNTY MUTUAL INSURANCE COMPANYRelativeDelays (Claims Handling)NoClaim Settled; Additional Monies Received2012-07-25T00:00:002012-10-05T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured3762Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN3270SCOTT AND WHITE HEALTH PLANInsuredUnsatisfactory Settle/OfferYesCorrective Action Taken; Additional Monies Received; Information Furnished2012-07-26T00:00:002012-09-05T00:00:00Health Maintenance OrgAccident and HealthGroup A&HThird Party Admin-Non Licensed788Health Maintenance OrgOrganizationINDV3271LIBERTY COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld; Contract Language/Legal Issue; Information Furnished2012-07-25T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person3762Ins Co - Licensed/ActiveOrganizationINDVHAIL; UNDERWRITING CRITERIA3272Property Damage Restoration ServicesAgentUnauthorized ActsNoInsufficient Information2012-07-25T00:00:002012-10-22T00:00:00Property and CasualtyFire, Allied Lines & CMPBusiness Owners67795Unauthorized ActivityOrganizationINDV3273ALLSTATE TEXAS LLOYD'SInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished2012-07-26T00:00:002012-10-03T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person3721Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING3274ALLSTATE INDEMNITY COMPANYInsuredPremium and Rating; Refund Of PremiumNoInformation Furnished; Company Position Upheld2012-07-24T00:00:002012-09-24T00:00:00Property and CasualtyHomeownersHomeowners167Ins Co - Licensed/ActiveOrganizationINDV3275CURLEY, KEVIN MICHAELInsuredOtherNoInformation Furnished2012-07-25T00:00:002013-03-07T00:00:00Property and CasualtyLiabilityGeneral Liability57983AgentIndividualINDV3277AETNA LIFE INSURANCE COMPANYProviderRecoupment Of Claims PaymentNoNo Jurisdiction2012-07-25T00:00:002012-08-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG3278MAXUM INDEMNITY COMPANYInsuredCancellationNoInformation Furnished; Cancel/Non-Renewal Upheld2012-07-24T00:00:002012-10-04T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines51979Ins Co - Surplus LinesOrganizationINDV3278CROUCH, GREGORY KYLEInsuredAgent HandlingNoInformation Furnished2012-07-24T00:00:002012-10-04T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines57981AgentIndividualINDV3279INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA, THEThird PartyCust Service Claim Handling; Delays (Claims Handling); Denial Of ClaimNoContract Language/Legal Issue; Question of Fact; Information Furnished2012-07-25T00:00:002012-11-27T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied LinesAssociated Subject Person; Insured Company2296Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF3280DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Claim Settled2012-07-24T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; UNCOOPERATIVE INSURED3281HUMANA HEALTH PLAN OF TEXAS, INC.ProviderNot Within TDI JurisdictionNoContract Language/Legal Issue; No Jurisdiction2012-07-26T00:00:002012-09-28T00:00:00Health Maintenance OrgAccident and HealthGroup A&HGR Elected Official702Health Maintenance OrgOrganizationORG3282WELLCARE OF TEXAS, INC.AgentAgent Handling; Lead Cards; MisrepresentationNoInformation Furnished2012-07-26T00:00:002012-10-23T00:00:00Medicare Managed Care for HMOAccident and HealthIndividual A & HAssociated Subject Person; Insured28079Health Maintenance OrgOrganizationINDVSENIOR CITIZEN3282CRUZ, DANIEL LEONARDOAgentAgent Handling; Lead Cards; MisrepresentationNoQuestion of Fact2012-07-26T00:00:002012-10-23T00:00:00Medicare Managed Care for HMOAccident and HealthIndividual A & HAssociated Subject Person; Insured288692AgentIndividualINDVSENIOR CITIZEN3283UNITEDHEALTHCARE INSURANCE COMPANYProviderRecoupment Of Claims PaymentNoNo Jurisdiction2012-07-26T00:00:002012-08-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationORG3284UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.ProviderRecoupment Of Claims PaymentNoNo Jurisdiction2012-07-26T00:00:002012-08-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&H3425Health Maintenance OrgOrganizationORG3285STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-07-26T00:00:002012-09-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF; DAMAGE DISPUTE; DIMINISHED VALUE3286BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderPrompt Pay; Unsatisfactory Settle/OfferNoCompany Position Upheld; Claim Not Clean2012-07-25T00:00:002012-10-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Health Maintenance OrgOrganizationORG3287BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoInformation Furnished2012-08-03T00:00:002012-12-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company10047Ins Co - Licensed/ActiveOrganizationINDV3288CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDenial Of Claim; Medical NecessityNoNo Jurisdiction2012-07-25T00:00:002013-04-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Self-Funded / ErisaOrganizationORGGR-Claim Evaluation3289ALLSTATE PROPERTY AND CASUALTY INSURANCE COMPANYProviderDelays (Claims Handling)NoCompany Position Upheld2012-08-01T00:00:002012-08-29T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person3463Ins Co - Licensed/ActiveOrganizationORG3290BLUEBONNET PRIDE INSURANCE AGENCY INCAgentCommissionsYes2012-08-01T00:00:002012-10-23T00:00:00Property and CasualtyMiscellaneousP & C Misc10186AgentOrganizationINDV3290DSMIIG HILL COUNTRY, LLCAgentCommissionsYesReferred for Disciplinary Actn2012-08-01T00:00:002012-10-23T00:00:00Property and CasualtyMiscellaneousP & C Misc36913AgentOrganizationINDV3291APPLIED RESOLUTIONS LLCInjured EmployeeIRO Failed To Obtn Med Rcrds; Inaccurate Info In IRO DecsnNoInformation Furnished2012-07-24T00:00:002012-10-24T00:00:00Independent Review OrgMiscellaneousWorkers' Compensation44304Independent Review Org (Iro)OrganizationINDV3292LIBERTY INSURANCE UNDERWRITERS INCInsuredDenial Of ClaimNoCompany Position Upheld2012-07-31T00:00:002012-09-05T00:00:00Property and CasualtyMiscellaneousP & C MiscAssociated Subject Company73533Ins Co - Licensed/ActiveOrganizationINDV3293ALLSTATE LIFE INSURANCE COMPANYRelativeAgent Handling; Misrepresentation; Refund Of PremiumNoQuestion of Fact; Contract Language/Legal Issue2012-08-06T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured169Ins Co - Licensed/ActiveOrganizationINDV3294TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredDisaster; Non-RenewalNoRecord Only2012-08-01T00:00:002012-09-12T00:00:00Property and CasualtyHomeownersHomeowners1444Ins Co - Licensed/ActiveOrganizationINDV2012 NORTH TEXAS TORNADOES3295DRIVER'S INSURANCE COMPANYInsuredDelays (Claims Handling)NoAdditional Monies Received; Claim Settled2012-08-01T00:00:002012-11-13T00:00:00Property and CasualtyAutomobileIndividual Private PassGR Elected Official2038Ins Co - Licensed/ActiveOrganizationINDV3296JOHN ALDEN LIFE INSURANCE COMPANYProviderDenial Of ClaimNoClaim Settled2012-07-25T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured2495Ins Co - Licensed/ActiveOrganizationORGBUNDLING; GR-Claim Evaluation3297ALLSTATE COUNTY MUTUAL INSURANCE COMPANYProviderDelays (Claims Handling)NoCompany Position Upheld2012-08-03T00:00:002012-09-14T00:00:00Property and CasualtyAccident and HealthGroup A&HInsured2228Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3298TEXAS STAR NETWORK/COVENTRYContracted ProviderDenial Of ClaimNoContract Language/Legal Issue2012-07-25T00:00:002012-11-07T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Company; Insured55311WC Healthcare Provider NtwkOrganizationORG3299HARTFORD ACCIDENT AND INDEMNITY COMPANYAgentUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-08-06T00:00:002012-09-11T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied LinesInsured Company2380Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; MOLD; WATER DAMAGE3300VISION INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Company Position Upheld2012-07-25T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private PassThird Party Admin-Non Licensed23478Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED3302BURKHALTER, BRADLY GLENInsuredConversionYesReferred for Disciplinary Actn; Failure to Timely Respond2012-07-25T00:00:002012-10-23T00:00:00Property and CasualtyHomeownersHomeowners GroupCorrespondent Company731464AgentIndividualINDV3303GARRISON PROPERTY AND CASUALTY INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld2012-07-26T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileBusiness Automobile1697Ins Co - Licensed/ActiveOrganizationINDV3304FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-07-26T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVLOSS OF USE3306DRIVER'S INSURANCE COMPANYLienholderDelays (Claims Handling)NoInformation Furnished; Claim Settled; Additional Monies Received2012-07-26T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; TOTAL LOSS3307AMERICAN HALLMARK INSURANCE COMPANY OF TEXASInsuredDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-07-26T00:00:002012-10-19T00:00:00Property and CasualtyHomeownersRental699Ins Co - Licensed/ActiveOrganizationINDV3309OCWEN LOAN SERVICING LLCInsuredDelays (Claims Handling)NoInsufficient Information2012-07-26T00:00:002012-10-23T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company67808Mortgage LenderOrganizationINDV3311INFINITY COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Question of Fact2012-07-26T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured1197Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF; GR-Claim Evaluation3312TEXAS FARMERS INSURANCE COMPANYInsuredPremium and Rating; Refund Of PremiumYesInformation Furnished; Corrective Action Taken2012-07-26T00:00:002012-10-12T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; UNDERWRITING CRITERIA3313AMMAD HIJA INSURANCE AGENCY INCAgentCommissionsNoNo Jurisdiction2012-07-26T00:00:002012-09-27T00:00:00Property and CasualtyMiscellaneousNo Line Specified43396Insurance AgencyOrganizationORG3314FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyLiability DisputeNoContract Language/Legal Issue; Information Furnished; Question of Fact2012-07-26T00:00:002012-09-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF3315STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled; Information Furnished2012-07-26T00:00:002012-10-04T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDV3316ACCC INSURANCE COMPANYThird PartyDenial Of ClaimNoContract Language/Legal Issue; Question of Fact; Information Furnished2012-07-26T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF3317STATE FARM LLOYDSInsuredDenial Of ClaimNoInformation Furnished2012-07-25T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVHAIL; ROOF3318INFINITY AUTO INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling)NoClaim Settled; Additional Monies Received2012-07-26T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass7669Ins Co - Licensed/ActiveOrganizationINDV3319AMERICA FIRST INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received; Information Furnished; Claim Settled2012-07-26T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass16071Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; SUPPLEMENTARY PAYMENT3320FOREMOST LLOYDS OF TEXASInsuredDenial Of ClaimNoAdditional Monies Received; Claim Settled; Information Furnished2012-07-26T00:00:002012-09-24T00:00:00Property and CasualtyHomeownersHomeowners698Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; HAIL; ROOF3322ALLSTATE INDEMNITY COMPANYRelativeDenial Of ClaimNoContract Language/Legal Issue; Information Furnished; Question of Fact2012-07-26T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private PassAlias Name167Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF3323ALLSTATE COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Underwriting); Refund Of PremiumNoCompany Position Upheld; Information Furnished2012-07-26T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass2228Ins Co - Licensed/ActiveOrganizationINDV3324MURPHY, CHRISTOPHER VERNONInsuredConversionYesFailure to Timely Respond; Referred for Disciplinary Actn2012-07-26T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeownersCorrespondent Company659500AgentIndividualINDV3325LOYA INSURANCE COMPANYInsuredPremium and RatingYesCorrective Action Taken; Information Furnished; Additional Payment Expected2012-07-26T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private Pass15643Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA3326AMERICAN BANKERS LIFE ASSURANCE COMPANY OF FLORIDAInsuredRefund Of PremiumNoInformation Furnished2012-07-26T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H177Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; SENIOR CITIZEN3327METROPOLITAN LLOYDS INSURANCE COMPANY OF TEXASInsuredDelays (Underwriting)NoCompany Position Upheld2012-07-26T00:00:002012-10-22T00:00:00Property and CasualtyHomeownersHomeowners3848Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA3327KOUSER INSURANCE INCInsuredAgent HandlingNoCompany Position Upheld2012-07-26T00:00:002012-10-22T00:00:00Property and CasualtyHomeownersHomeowners21670AgentOrganizationINDVUNDERWRITING CRITERIA3328NOVA CASUALTY COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)NoInformation Furnished; Complainant Retained Attorney; Contract Language/Legal Issue2012-07-26T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company11173Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING3329LOYA INSURANCE COMPANYThird PartyDelays (Claims Handling)YesAdditional Monies Received; Information Furnished; Claim Settled2012-07-26T00:00:002012-10-09T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured15643Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING3330UNIVERSAL INSURANCE COMPANY OF NORTH AMERICAInsuredCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received; Claim Settled; Information Furnished2012-07-25T00:00:002012-10-23T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person; Third Party Admin-Non Licensed36359Ins Co - Licensed/ActiveOrganizationINDVAPPRAISAL; BURDEN OF PROOF; DAMAGE DISPUTE; HAIL; ROOF; WATER DAMAGE3331STATE FARM LLOYDSOtherUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-07-25T00:00:002012-09-12T00:00:00Property and CasualtyHomeownersHomeownersInsured3105Ins Co - Licensed/ActiveOrganizationORGHAIL; OVERHEAD AND PROFIT; ROOF3333ALLSTATE PROPERTY AND CASUALTY INSURANCE COMPANYProviderDelays (Claims Handling); Timely Filing DeficiencyNoOther2012-08-03T00:00:002012-11-12T00:00:00Life, Accident and HealthAutomobileIndividual Private PassInsured3463Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3334TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredCancellationNoInformation Furnished2012-07-26T00:00:002012-11-15T00:00:00Property and CasualtyHomeownersHomeowners Group1444TWIAOrganizationINDV3334HERNANDEZ, ERNIE JOSEPHInsuredAgent HandlingNoContract Language/Legal Issue; Question of Fact2012-07-26T00:00:002012-11-15T00:00:00Property and CasualtyHomeownersHomeowners Group647624AgentIndividualINDV3335STATE NATIONAL INSURANCE COMPANY, INC.InsuredPremium and RatingNoCompany Position Upheld; Information Furnished2012-07-26T00:00:002012-09-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass3242Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA3336TOWER NATIONAL INSURANCE COMPANYAgentDelays (Policyholder Service)NoInformation Furnished2012-07-25T00:00:002012-10-30T00:00:00Property and CasualtyLiabilityGeneral LiabilityInsured Company24997Ins Co - Licensed/ActiveOrganizationORG3336American Agency System Insurance ServicesAgentRefund Of PremiumYesFailure to Timely Respond2012-07-25T00:00:002012-10-30T00:00:00Property and CasualtyLiabilityGeneral LiabilityInsured Company75382OtherOrganizationORG3337ACCC INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished; Additional Monies Received; Claim Settled2012-07-25T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING3338FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and RatingNoCompany Position Upheld2012-07-25T00:00:002012-11-05T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent2623Ins Co - Licensed/ActiveOrganizationINDV3339CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderCoordination of Benefits; Delays (Claims Handling); Timely Filing DeficiencyNoInsufficient Information2012-07-26T00:00:002012-11-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3340INDEPENDENCE TITLE COMPANYConsumer (Non-Insured)OtherNoCancellation Withdrawn2012-07-26T00:00:002012-09-11T00:00:00Property and CasualtyMiscellaneousTitle Insurance66531AgentOrganizationINDV3341AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue; No Jurisdiction2012-07-24T00:00:002012-09-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3343OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYProviderDenial Of ClaimNoInformation Furnished; Other2012-02-29T00:00:002012-08-16T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1823Ins Co - Licensed/ActiveOrganizationORG3344OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished2012-07-25T00:00:002013-07-23T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVAFTERMARKET PARTS; DAMAGE DISPUTE; GR-Claim Evaluation; LOSS OF USE3345AAA TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of Claim; Unsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished; Contract Language/Legal Issue2012-07-25T00:00:002012-10-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass2286Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF; DAMAGE DISPUTE; SUPPLEMENTARY PAYMENT; UNDERWRITING CRITERIA3346GRAMERCY INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Additional Monies Received2012-07-26T00:00:002012-10-02T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured; Third Party Admin-Licensed1062Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; LOSS OF USE3347UNITEDHEALTHCARE INSURANCE COMPANYInsuredDelays (Claims Handling)NoNo Jurisdiction2012-07-25T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person1348Ins Co - Licensed/ActiveOrganizationINDV3347VALUEOPTIONS, INC.InsuredDelays (Claims Handling)No2012-07-25T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person44252Third Party AdministratorsOrganizationINDV3349GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-07-26T00:00:002012-10-10T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2486Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3350CONSECO LIFE INSURANCE COMPANY OF TEXASInsuredRefund Of PremiumNoContract Language/Legal Issue; Information Furnished2012-07-25T00:00:002012-09-12T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured19572Ins Co - Licensed/ActiveOrganizationINDV3351ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-07-25T00:00:002012-10-01T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3352STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredLiability DisputeNoCompany Position Upheld2012-07-25T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV3353BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoNo Jurisdiction2012-07-25T00:00:002012-09-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationINDV3354PROPERTY AND CASUALTY INSURANCE COMPANY OF HARTFORDInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld2012-07-08T00:00:002013-09-27T00:00:00Property and CasualtyHomeownersHomeownersGR Elected Official; Insured8123Ins Co - Licensed/ActiveOrganizationINDVAPPRAISAL; ENGINEER'S REPORT; FOUNDATION ; OVERHEAD AND PROFIT; WATER DAMAGE3356BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/Offer; Usual And CustomaryNoNo Jurisdiction2012-07-25T00:00:002012-08-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG3357GERBER LIFE INSURANCE COMPANYRelativeXX-Coverage QuestionYesInformation Furnished2012-07-25T00:00:002012-09-28T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured2465Ins Co - Licensed/ActiveOrganizationINDV3358STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYRelativeOtherNoOther2012-07-26T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Third Party Admin-Non Licensed1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation3358FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYRelativeDelays (Claims Handling); Denial Of ClaimNoQuestion of Fact; Information Furnished2012-07-26T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Third Party Admin-Non Licensed2623Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation3359CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoInsufficient Information2012-07-24T00:00:002012-11-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationINDV3361STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredDelays (Claims Handling)NoClaim Settled; Information Furnished2012-07-26T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV3365METROPOLITAN LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished2012-07-18T00:00:002012-10-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&H13191Ins Co - Licensed/ActiveOrganizationINDV3366STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYProviderAssignment of BenefitsYesContract Language/Legal Issue; Information Furnished2012-07-26T00:00:002012-10-10T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationORGBURDEN OF PROOF3368PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimYesInformation Furnished2012-07-26T00:00:002012-10-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDV3370GATEWAY INSURANCE COMPANYConsumer (Non-Insured)Denial Of ClaimNoInformation Furnished; Question of Fact2012-07-25T00:00:002012-10-02T00:00:00Property and CasualtyAutomobileBusiness AutomobileInsured Company7621Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3371HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredNon-RenewalNoCompany Position Upheld; Information Furnished2012-07-26T00:00:002012-10-05T00:00:00Property and CasualtyAutomobileIndividual Private Pass2362Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNDERWRITING CRITERIA3372FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Policyholder Service)NoCorrective Action Taken; Information Furnished2012-07-26T00:00:002012-10-05T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDV3373HUMANA INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-26T00:00:002012-09-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN3376GERMANIA FARM MUTUAL INSURANCE ASSOCIATIONInsuredDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-07-26T00:00:002012-09-28T00:00:00Property and CasualtyHomeownersHomeowners2468Ins Co - Licensed/ActiveOrganizationINDVHAIL; ROOF3377OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Question of Fact2012-07-26T00:00:002012-10-02T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3379OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; Company Position Upheld2012-07-26T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; UNCOOPERATIVE INSURED3380SAN ANTONIO INDEMNITY COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished2012-07-26T00:00:002012-10-01T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent975Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3381ACCC INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received; Information Furnished2012-07-26T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF; DAMAGE DISPUTE3382ACCC INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling)NoCompany Position Upheld2012-07-25T00:00:002012-10-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDV3383OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDelays (Claims Handling); Denial Of ClaimYesCompany Position Upheld2012-07-26T00:00:002012-11-05T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDV3384CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-07-25T00:00:002012-10-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORG3387AMERICAN BANKERS INSURANCE COMPANY OF FLORIDAConsumer (Non-Insured)Denial Of Claim; Unsatisfactory Settle/OfferNoCompany Position Upheld2012-07-27T00:00:002012-11-06T00:00:00Property and CasualtyHomeownersMobile HomeownerInsured176Ins Co - Licensed/ActiveOrganizationINDVWATER DAMAGE3389FAMILY HERITAGE LIFE INSURANCE COMPANY OF AMERICAInsuredDelays (Policyholder Service); Refund Of PremiumYesPremium Refunded; Additional Monies Received2012-07-26T00:00:002012-10-05T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured3535Ins Co - Licensed/ActiveOrganizationINDV3390HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredEndorsement / Rider; Unsatisfactory Settle/OfferNoCompany Position Upheld2012-07-27T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Company2362Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; POLICY EXCLUSION3392AMERICAN ACCESS CASUALTY COMPANYInsuredDelays (Claims Handling)NoClaim Settled2012-07-26T00:00:002012-11-06T00:00:00Property and CasualtyAutomobileIndividual Private Pass30332Ins Co - Licensed/ActiveOrganizationINDVTOTAL LOSS3397UNITED SPECIALTY INSURANCE COMPANYAttorneyDelays (Claims Handling)NoFailure to Timely Respond; Additional Monies Received2012-07-27T00:00:002012-09-21T00:00:00Property and CasualtyLiabilityGeneral LiabilityAssociated Agent; Associated Subject Company; Insured; Insured Company53435Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING3398PRINCIPAL LIFE INSURANCE COMPANYInsuredAgent Handling; Cancellation; MisrepresentationNoContract Language/Legal Issue2012-08-07T00:00:002012-09-12T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeGR Elected Official3032Ins Co - Licensed/ActiveOrganizationINDVRESCISSION3399WESTERN INSURANCE COMPANYInsuredDelays (Claims Handling); Denial Of ClaimYesNo Jurisdiction2012-07-30T00:00:002012-10-01T00:00:00Property and CasualtyMiscellaneousWarranty ContractAssociated Subject Company22374Ins Co - Licensed/ReceivershipOrganizationINDV3400USAA GENERAL INDEMNITY COMPANYInsuredRefund Of PremiumNoPremium Refunded2012-07-30T00:00:002012-10-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass1276Ins Co - Licensed/ActiveOrganizationINDV3401METROPOLITAN CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferYesClaim Settled2012-07-30T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private Pass1245Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3402METROPOLITAN LIFE INSURANCE COMPANYProviderDelays (Claims Handling); Timely Filing DeficiencyNoNo Jurisdiction2012-07-20T00:00:002012-10-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured13191Self-Funded / ErisaOrganizationORGGR-Claim Evaluation3404TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICAAttorneyDelays (Claims Handling)NoInformation Furnished2012-07-30T00:00:002012-10-04T00:00:00Property and CasualtyMiscellaneousFidelity & Surety3714Ins Co - Licensed/ActiveOrganizationINDV3405FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYAttorneyUnsatisfactory Settle/OfferNoCompany Position Upheld2012-07-30T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured2623Ins Co - Licensed/ActiveOrganizationORG3406UNITEDHEALTHCARE INSURANCE COMPANYInsuredBalance Billing; Denial Of Pymt For Emerg CareYesClaim Settled; Additional Monies Received2012-07-26T00:00:002012-11-06T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDVEMERGENCY CARE; GR-Claim Evaluation3408HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Delays (Policyholder Service)NoInformation Furnished2012-07-30T00:00:002012-09-20T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency2362Ins Co - Licensed/ActiveOrganizationINDV3409TEXAS MEDICAID & HEALTHCARE PARTNERSHIPOtherNot Within TDI JurisdictionNoRecord Only2012-07-25T00:00:002012-10-15T00:00:00Property and CasualtyMiscellaneousFederal ProgramsInsured66518Govermental EntityOrganizationORG3411GRAMERCY INSURANCE COMPANYInsuredRefund Of PremiumNoCompany Position Upheld; Information Furnished2012-07-30T00:00:002012-10-21T00:00:00Property and CasualtyAutomobileTruckers PolicyAssociated Subject Agency1062Ins Co - Licensed/ActiveOrganizationINDV3411HALLMARK COUNTY MUTUAL INSURANCE COMPANYInsuredRefund Of PremiumNoInformation Furnished; Company Position Upheld2012-07-30T00:00:002012-10-21T00:00:00Property and CasualtyAutomobileTruckers PolicyAssociated Subject Agency1505Ins Co - Licensed/ActiveOrganizationINDV3411MILLENIUM INSURANCE SERVICES INCInsuredAgent HandlingNoCompany Position Upheld; Information Furnished2012-07-30T00:00:002012-10-21T00:00:00Property and CasualtyAutomobileTruckers PolicyAssociated Subject Agency9454Insurance AgencyOrganizationINDV3412UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of Claim; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-26T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3413GMAC INSURANCE COMPANY ONLINE, INC.AgentOtherNoRecord Only2012-07-26T00:00:002012-08-15T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured; Third Party Admin-Non Licensed14210No Entity Complained AgainstOrganizationINDV3414MGA INSURANCE COMPANY, INC.InsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-07-30T00:00:002012-11-14T00:00:00Property and CasualtyAutomobileIndividual Private Pass812Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3415TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICAAttorneyUse of Credit ReportsNoCompany Position Upheld2012-07-30T00:00:002012-10-26T00:00:00Property and CasualtyMiscellaneousNo Line SpecifiedAssociated Subject Company; Insured3714Ins Co - Licensed/ActiveOrganizationINDVCREDIT REPORT3416AETNA LIFE INSURANCE COMPANYPhysicianDelays (Claims Handling); Unsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-07-26T00:00:002012-09-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3417DRIVER'S INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)YesClaim Settled; Additional Monies Received2012-07-30T00:00:002012-11-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation3419Enhancement ServicesConsumer (Non-Insured)Delays (Claims Handling)YesAdditional Monies Received2012-07-26T00:00:002012-10-10T00:00:00Property and CasualtyMiscellaneousWarranty Contract67844OtherOrganizationINDV3420TEXAS FARMERS INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Question of Fact2012-07-30T00:00:002012-10-23T00:00:00Property and CasualtyHomeownersHomeownersInsured1452Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3421ALLSTATE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received; Additional Payment Expected2012-07-30T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Associated Subject Person2228Ins Co - Licensed/ActiveOrganizationINDV3423SOUTHERN COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Underwriting); Duplication of Coverage; Excessive Rates; Premium and RatingNoCompany Position Upheld; Information Furnished2012-07-30T00:00:002012-10-23T00:00:00Property and CasualtyMiscellaneousP & C MiscAssociated Subject Company1583Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNCOOPERATIVE INSURED; UNDERWRITING CRITERIA3424VAN WAGONER COMPANIES INCInsuredOtherNoPolicy Not In Force2012-07-30T00:00:002012-12-07T00:00:00Property and CasualtyHomeownersHomeowners4826Insurance AgencyOrganizationINDVCOVERAGE DISPUTE3424AMERICAN RISK INSURANCE COMPANY, INC.InsuredDelays (Policyholder Service)NoCompany Position Upheld2012-07-30T00:00:002012-12-07T00:00:00Property and CasualtyHomeownersHomeowners27377Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE3424DUNNING, CURNELL DInsuredAgent Handling; ConversionYesComplainant Retained Attorney2012-07-30T00:00:002012-12-07T00:00:00Property and CasualtyHomeownersHomeowners46491AgentIndividualINDVCOVERAGE DISPUTE3425PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoAdditional Monies Received; Information Furnished2012-07-26T00:00:002012-11-08T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1708Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation3426OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYLienholderDelays (Claims Handling)NoContract Language/Legal Issue; Information Furnished2012-07-30T00:00:002012-10-09T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationORGUNCOOPERATIVE INSURED3427OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyLiability Dispute; Unsatisfactory Settle/OfferNoAdditional Monies Received; Question of Fact2012-07-30T00:00:002012-10-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVCOMPARATIVE NEGLIGENCE; GR-Claim Evaluation3428UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling); Medical Necessity; Timely Filing DeficiencyNoCompany Position Upheld2012-07-26T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3429USAA CASUALTY INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling); Liability DisputeNoAdditional Monies Received; Information Furnished2012-07-30T00:00:002012-12-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass3607Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; LOSS OF USE; REPLACEMENT VEHICLE3430MURPHY, CHRISTOPHER VERNONInsuredAgent Handling; ConversionYesFailure to Timely Respond; Referred for Disciplinary Actn2012-07-30T00:00:002012-11-21T00:00:00Property and CasualtyHomeownersHomeowners Group659500AgentIndividualINDV3431CUNA MUTUAL LIFE INSURANCE COMPANYInsuredDelays (Policyholder Service)NoInformation Furnished2012-07-26T00:00:002012-10-11T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2138Ins Co - Licensed/ActiveOrganizationINDV3433AMERICAN HERITAGE LIFE INSURANCE COMPANYInsuredDenial Of Claim; Pre-Existing ConditionNoInformation Furnished; Contract Language/Legal Issue2012-07-26T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H162Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3434BRISTOL WEST SPECIALTY INSURANCE COMPANYProviderAssignment of BenefitsNoCompany Position Upheld; Information Furnished2012-07-28T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private Pass8129Ins Co - Licensed/ActiveOrganizationORG3435UNITED CONCORDIA DENTAL PLANS OF TEXAS, INC.ProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-26T00:00:002012-10-24T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured3681Ins Co - Licensed/ActiveOrganizationINDV3436JOHN ALDEN LIFE INSURANCE COMPANYInsuredPremium and RatingNoContract Language/Legal Issue2012-07-26T00:00:002012-10-27T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2495Ins Co - Licensed/ActiveOrganizationINDV3437CURLEY, KEVIN MICHAELInsuredDelays (Policyholder Service)NoInformation Furnished2012-07-30T00:00:002012-11-19T00:00:00Property and CasualtyLiabilityGeneral LiabilityInsured Company57983AgentIndividualINDV3438BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderPrompt Pay; SB418 Rule Violation; Unsatisfactory Settle/OfferNoInformation Furnished2012-07-26T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3439DRIVER'S INSURANCE COMPANYInsuredDelays (Policyholder Service); Refund Of PremiumYesPremium Refunded2012-07-30T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass2038Ins Co - Licensed/ActiveOrganizationINDV3440BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredCust Service Claim HandlingNoNo Jurisdiction2012-07-26T00:00:002012-09-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV3441HOME STATE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished2012-07-30T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Associated Subject Company; Insured2362Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; LOSS OF USE3443ACCESS INSURANCE COMPANYProviderDenial Of ClaimNoCompany Position Upheld2012-07-28T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private Pass2194Ins Co - Licensed/ActiveOrganizationORG3444TEXAS SERVICE LIFE INSURANCE COMPANYRelativeUnsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received2012-07-26T00:00:002012-09-28T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Agent; Correspondent Company; Deceased Person; Insured3325Ins Co - Licensed/ActiveOrganizationINDV3445CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDen/N-Pymt MD Nec Trmt N-Emrg; Type Of URA Reviewer UsedNoNo Jurisdiction2012-07-27T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthDiscount Health Care ProgramInsured2851Ins Co - Licensed/ActiveOrganizationORG3446SANTA FE AUTO INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoContract Language/Legal Issue2012-07-30T00:00:002012-11-14T00:00:00Property and CasualtyAutomobileIndividual Private Pass27766Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation3448OAK BROOK COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished2012-07-30T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private Pass2323Ins Co - Licensed/ActiveOrganizationINDVLOSS OF USE3449ATLANTIC CASUALTY INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Payment Expected2012-07-30T00:00:002012-12-10T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines52002Ins Co - Surplus LinesOrganizationINDVAPPRAISAL3450AMICA MUTUAL INSURANCE COMPANYInsuredPremium and RatingNoCompany Position Upheld2012-07-30T00:00:002012-10-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass3532Ins Co - Licensed/ActiveOrganizationINDV3451PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoCompany Position Upheld2012-07-30T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured1708Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3452HUMANA INSURANCE COMPANYInsuredCoordination of Benefits; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-26T00:00:002012-10-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation3453NEW YORK LIFE INSURANCE COMPANYInsuredCoordination of Benefits; Delays (Claims Handling)YesAdditional Payment Expected2012-07-26T00:00:002012-10-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1887Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation3453BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredCoordination of Benefits; Delays (Claims Handling)NoInformation Furnished2012-07-26T00:00:002012-10-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation3454Reliant Title Agency, LLCInsuredAgent HandlingNoCompany Position Upheld; Information Furnished2012-07-30T00:00:002012-10-26T00:00:00Property and CasualtyMiscellaneousTitle Insurance67853AgentOrganizationINDV3456Lawyers Title CompanyConsumer (Non-Insured)Earnest MoneyYesAdditional Payment Expected2012-07-30T00:00:002012-10-19T00:00:00Property and CasualtyMiscellaneousTitle InsuranceAssociated Subject Person66608AgentOrganizationINDV3457GREAT LAKES REINSURANCE (U.K.) PLCInsuredDelays (Claims Handling)NoAdditional Payment Expected; Information Furnished; Contract Language/Legal Issue2012-07-30T00:00:002013-01-22T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency49022Ins Co - Surplus LinesOrganizationINDV3458TEXAS BONDING COMPANYAttorneyDelays (Claims Handling)NoInformation Furnished; Contract Language/Legal Issue2012-07-30T00:00:002012-08-24T00:00:00Property and CasualtyMiscellaneousFidelity & Surety9381Ins Co - Licensed/ActiveOrganizationINDV3461D R Horton Home BuilderConsumer (Non-Insured)OtherNoReferred To2012-07-30T00:00:002012-08-15T00:00:00Property and CasualtyMiscellaneousP & C MiscThird Party Admin-Non Licensed67857OtherOrganizationINDV3462DAIRYLAND COUNTY MUTUAL INSURANCE COMPANY OF TEXASInsuredDelays (Policyholder Service)NoContract Language/Legal Issue; Information Furnished2012-07-30T00:00:002012-11-24T00:00:00Property and CasualtyAutomobileMotorcycle2737Ins Co - Licensed/ActiveOrganizationINDV3462FEARLESS SERVICES, L.L.C.InsuredDelays (Policyholder Service)YesFailure to Timely Respond2012-07-30T00:00:002012-11-24T00:00:00Property and CasualtyAutomobileMotorcycle46204AgentOrganizationINDV3463FOREMOST COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferYesClaim Settled; Additional Monies Received; Information Furnished2012-07-30T00:00:002012-10-02T00:00:00Property and CasualtyHomeownersHomeowners2530Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DEPRECIATION3464LIBERTY INSURANCE CORPORATIONInsuredDelays (Claims Handling)NoAdditional Monies Received; Appraisal Process Invoked2012-07-30T00:00:002012-10-18T00:00:00Property and CasualtyHomeownersHomeowners3636Ins Co - Licensed/ActiveOrganizationINDV3465BRISTOL WEST SPECIALTY INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished2012-07-30T00:00:002012-10-09T00:00:00Property and CasualtyAutomobileIndividual Private Pass8129Ins Co - Licensed/ActiveOrganizationINDV3466ALLSTATE INSURANCE COMPANYInsuredDelays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-07-30T00:00:002012-09-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass168Ins Co - Licensed/ActiveOrganizationINDV3467BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONPhysicianDenial Of Pymt For Emerg Care; Medical Necessity; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-28T00:00:002012-09-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3468GEICO INDEMNITY COMPANYConsumer (Non-Insured)Unsatisfactory Settle/OfferNoInformation Furnished2012-07-30T00:00:002012-10-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass2785Ins Co - Licensed/ActiveOrganizationORG3470COMPANION COMMERCIAL INSURANCE COMPANYInsuredDenial Of Claim; Endorsement / RiderNoInformation Furnished; Contract Language/Legal Issue2012-07-30T00:00:002012-10-18T00:00:00Property and CasualtyHomeownersHomeowners10483Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE3472BALBOA INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferYesInformation Furnished; Additional Payment Expected; Additional Monies Received2012-07-30T00:00:002012-10-18T00:00:00Property and CasualtyHomeownersHomeowners3083Ins Co - Licensed/ActiveOrganizationINDVHAIL; ROOF3473BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONPhysicianDenial Of ClaimNoClaim Settled; Insufficient Information2012-07-26T00:00:002012-09-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; PRESCRIPTION3474AMERICAN-AMICABLE LIFE INSURANCE COMPANY OF TEXASAgentDelays (Underwriting)YesInformation Furnished2012-07-27T00:00:002012-09-27T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured745Ins Co - Licensed/ActiveOrganizationINDVROOF; SENIOR CITIZEN3474LOPEZ, ARMANDOAgentDelays (Underwriting)YesInsufficient Information2012-07-27T00:00:002012-09-27T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured92539AgentIndividualINDVROOF; SENIOR CITIZEN3476MARYLAND CASUALTY COMPANYInsuredDelays (Policyholder Service)NoInformation Furnished2012-07-30T00:00:002012-12-12T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied LinesCorrespondent Person2109Ins Co - Licensed/ActiveOrganizationORG3477OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled; Additional Monies Received2012-07-30T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Associated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COMPARATIVE NEGLIGENCE; UNCOOPERATIVE INSURED3478AMERICAN NATIONAL INSURANCE COMPANYInsuredPremium NoticeNoInformation Furnished2012-07-26T00:00:002012-09-04T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life135Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE3480WESCO INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-07-30T00:00:002012-10-04T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1200Ins Co - Licensed/ActiveOrganizationINDVACV; GR-Claim Evaluation; TOTAL LOSS3481AMERICAN FAMILY LIFE ASSURANCE COMPANY OF COLUMBUSBeneficiaryCash Value; Unsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-07-26T00:00:002012-09-10T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person2655Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation3482QBE INSURANCE CORPORATIONInsuredCancellation; Delays (Policyholder Service); Premium NoticeNoCorrective Action Taken; Information Furnished2012-07-30T00:00:002012-11-17T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency3331Ins Co - Licensed/ActiveOrganizationINDV3483OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDenial Of ClaimNoContract Language/Legal Issue; Company Position Upheld2012-07-30T00:00:002012-11-17T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED3484PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-07-30T00:00:002012-09-28T00:00:00Property and CasualtyMiscellaneousP & C Misc1708Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3485FIRE INSURANCE EXCHANGEInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-07-30T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass2606Ins Co - Licensed/ActiveOrganizationINDV3486METROPOLITAN LIFE INSURANCE COMPANYInsuredAgent Handling; Misrepresentation; Refund Of PremiumNoOther2012-08-06T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life13191Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE3487UNITED SERVICES AUTOMOBILE ASSOCIATIONInsuredUnsatisfactory Settle/OfferNoClaim Settled; Information Furnished; Additional Monies Received2012-07-30T00:00:002012-10-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass1254Ins Co - Licensed/ActiveOrganizationINDVACV; GR-Claim Evaluation; TOTAL LOSS3488LIBERTY COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Additional Payment Expected2012-07-30T00:00:002012-10-21T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured3762Ins Co - Licensed/ActiveOrganizationINDVDIMINISHED VALUE3489ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling)NoQuestion of Fact2012-07-30T00:00:002012-09-20T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDV3490Stewart Title CompanyConsumer (Non-Insured)OtherYesOther2012-07-30T00:00:002012-09-12T00:00:00Property and CasualtyMiscellaneousTitle Insurance66600AgentOrganizationINDV3491River Crest HospitalInsurance CompanyOverchargesNoNo Jurisdiction2012-08-06T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person68409Hospital / Doctor / DentistOrganizationINDV3493STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Complainant Retained Attorney2012-07-30T00:00:002012-09-20T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3494STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Claim Settled2012-07-30T00:00:002012-10-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV3496OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled2012-07-30T00:00:002012-10-10T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVREPLACEMENT VEHICLE3498UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoCompany Position Upheld2012-07-26T00:00:002012-10-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3499AMERICAN BANKERS INSURANCE COMPANY OF FLORIDAInsuredDelays (Policyholder Service); Refund Of PremiumYesPremium Refunded; Information Furnished2012-07-30T00:00:002012-10-15T00:00:00Property and CasualtyHomeownersRental176Ins Co - Licensed/ActiveOrganizationINDV3500DRIVER'S INSURANCE COMPANYAttorneyDelays (Claims Handling)NoCompany Position Upheld; Claim Settled2012-07-27T00:00:002012-10-04T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING3501ASI LLOYDSInsuredCancellation; Premium NoticeNoQuestion of Fact; Company Position Upheld; Cancel/Non-Renewal Upheld2012-07-30T00:00:002013-07-03T00:00:00Property and CasualtyHomeownersHomeownersInsured14728Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA3502OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYConsumer (Non-Insured)Delays (Claims Handling); Unsatisfactory Settle/OfferNoContract Language/Legal Issue2012-07-30T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING3503TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Question of Fact; Company Position Upheld2012-07-30T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1450Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation; SUPPLEMENTARY PAYMENT3504AETNA LIFE INSURANCE COMPANYProviderDen/N-Pymt MD Nec Trmt N-Emrg; Denial Of Claim; Medical NecessityNoNo Jurisdiction2012-07-26T00:00:002012-08-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3505STATE FARM LLOYDSInsuredNon-RenewalNoInformation Furnished2012-07-30T00:00:002012-10-11T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDV3507COMPANION PROPERTY AND CASUALTY INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling)NoInformation Furnished; Contract Language/Legal Issue2012-07-30T00:00:002012-11-26T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent; Third Party Admin-Licensed10484Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; DEDUCTIBLE; ENGINEER'S REPORT; FOUNDATION ; POLICY EXCLUSION3510MGA INSURANCE COMPANY, INC.Third PartyUnsatisfactory Settle/OfferNoQuestion of Fact2012-07-30T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured812Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation3511FIDELITY NATIONAL INSURANCE COMPANYInsuredNon-RenewalYesInformation Furnished; Cancellation Withdrawn2012-07-30T00:00:002012-10-18T00:00:00Property and CasualtyHomeownersHomeowners17916Ins Co - Licensed/ActiveOrganizationINDVROOF3512GEICO GENERAL INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished2012-07-30T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2684Ins Co - Licensed/ActiveOrganizationINDV3514STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-07-30T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA3515LIBERTY COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoAdditional Monies Received2012-07-30T00:00:002012-11-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass3762Ins Co - Licensed/ActiveOrganizationINDV3516UNITEDHEALTHCARE OF TEXAS, INC.Injured EmployeeContinuity Of Treatment; OtherNoNo Jurisdiction; Information Furnished2012-07-27T00:00:002012-10-05T00:00:00Workers Compensation NetworkAccident and HealthGroup A&HAssociated Subject Person3363WC Healthcare Provider NtwkOrganizationINDV3517BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderRecoupment Of Claims PaymentNoNo Jurisdiction2012-07-27T00:00:002012-09-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG3518AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesCorrective Action Taken; Information Furnished; Additional Monies Received2012-07-27T00:00:002012-11-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Correspondent Person; Insured245Ins Co - Licensed/ActiveOrganizationORG3519BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction2012-07-27T00:00:002012-09-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG3520UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of Claim; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-27T00:00:002012-09-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured1348Ins Co - Licensed/ActiveOrganizationORG3523INDEPENDENCE TITLE COMPANYConsumer (Non-Insured)Refund Of PremiumNoCancellation Withdrawn2012-07-26T00:00:002012-09-11T00:00:00Property and CasualtyMiscellaneousTitle Insurance66531AgentOrganizationINDV3525GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Question of Fact; Contract Language/Legal Issue2012-07-27T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF3526UNITRIN COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoCompany Position Upheld; Additional Monies Received2012-07-27T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass1856Ins Co - Licensed/ActiveOrganizationINDV3527HUMANA INSURANCE COMPANYInsuredPremium and RatingNoInsufficient Information2012-07-26T00:00:002012-11-09T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1040Ins Co - Licensed/ActiveOrganizationINDVFEDERAL HEALTH CARE REFORM3530TEXAS FARMERS INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld; Question of Fact; Contract Language/Legal Issue2012-07-30T00:00:002012-11-17T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDVMOLD; WATER DAMAGE3532AMERIGROUP TEXAS, INC.ProviderCust Service Claim Handling; Denial Of ClaimNoInformation Furnished; No Jurisdiction2012-07-30T00:00:002012-08-29T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Person; Insured8032Health Maintenance OrgOrganizationORGMULTIPLE INSUREDS3534BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction2012-07-27T00:00:002012-09-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV3535LIBERTY LLOYDS OF TEXAS INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received; Claim Settled2012-07-30T00:00:002012-10-25T00:00:00Property and CasualtyHomeownersHomeownersInsured11084Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3537BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-07-30T00:00:002012-09-10T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationINDV3538HUMANA INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Additional Monies Received2012-07-30T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN3539OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeNoCompany Position Upheld; Information Furnished2012-07-31T00:00:002012-09-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNDERWRITING CRITERIA3540BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDelays (Claims Handling); Unsatisfactory Settle/Offer; Usual And CustomaryNoInformation Furnished; Contract Language/Legal Issue2012-07-30T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Agency; Associated Subject Company10047Ins Co - Licensed/ActiveOrganizationINDV3542ALLSTATE INDEMNITY COMPANYOtherUnsatisfactory Settle/OfferNoInformation Furnished; Question of Fact2012-07-31T00:00:002012-10-05T00:00:00Property and CasualtyHomeownersHomeowners167Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; OVERHEAD AND PROFIT3543HUMANA INSURANCE COMPANYInsuredRefund Of PremiumNoPremium Refunded2012-07-30T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationINDVFEDERAL HEALTH CARE REFORM3544BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/Offer; Usual And CustomaryNoInformation Furnished2012-07-30T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV3545OCHUKO, ANTHONY TOBOREInsuredMisrepresentationNoContract Language/Legal Issue; Question of Fact2012-07-30T00:00:002013-01-25T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H964110AgentIndividualINDV3546PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of Claim; Unsatisfactory Settle/OfferYesQuestion of Fact2012-07-27T00:00:002012-11-17T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1708Ins Co - Licensed/ActiveOrganizationINDV3547UNITEDHEALTHCARE INSURANCE COMPANYInsuredDen/N-Pymt MD Nec RXYesInformation Furnished; Claim Settled2012-07-30T00:00:002012-09-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company1348Ins Co - Licensed/ActiveOrganizationINDVPRESCRIPTION3549Regent Care CentersInsuredOtherNoNo Jurisdiction2012-07-30T00:00:002012-08-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&H67896EmployerOrganizationINDV3550FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Question of Fact2012-07-31T00:00:002012-11-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVACV; GR-Claim Evaluation; TOTAL LOSS3551MEDCO HEALTH, L.L.C.InsuredDelays (Claims Handling)NoNo Jurisdiction2012-07-30T00:00:002012-11-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&H54629Self-Funded / ErisaOrganizationINDV3552UNITEDHEALTHCARE INSURANCE COMPANYInsuredBalance Billing; Unsatisfactory Settle/OfferYesAdditional Monies Received2012-07-30T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3553HUMANA INSURANCE COMPANYInsuredCOBRA; Cancellation; Cust Service Claim HandlingNoQuestion of Fact; Contract Language/Legal Issue2012-07-30T00:00:002012-11-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationINDV3555METROPOLITAN LIFE INSURANCE COMPANYRelativeDelays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-07-30T00:00:002012-10-13T00:00:00Life, Accident and HealthLife & AnnuityGroup LifeDeceased Person13191Ins Co - Licensed/ActiveOrganizationINDV3558DRIVER'S INSURANCE COMPANYLienholderDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-07-31T00:00:002012-09-21T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Person; Insured2038Ins Co - Licensed/ActiveOrganizationORGCOVERAGE DISPUTE; POLICY EXCLUSION; UNDERWRITING CRITERIA35591-Stop Auto InsuranceConsumer (Non-Insured)ConversionYesPolicy Not In Force2012-07-30T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private Pass75658Insurance AgencyOrganizationINDV3561CORESOURCE, INC.ProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-30T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured21922Self-Funded / ErisaOrganizationORGGR-Claim Evaluation3561MERITAIN HEALTH, INC.ProviderDelays (Claims Handling)NoNo Jurisdiction2012-07-30T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured26499Self-Funded / ErisaOrganizationORGGR-Claim Evaluation356221ST CENTURY CENTENNIAL INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-07-30T00:00:002013-02-20T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person771Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; LOSS OF USE; REPLACEMENT VEHICLE3564U.S. RISK, INC.InsuredCancellationNoInformation Furnished2012-07-31T00:00:002012-10-16T00:00:00Property and CasualtyLiabilityGeneral Liability5227Insurance AgencyOrganizationINDV3564IPFS CORPORATIONInsuredRefund Of PremiumNoInformation Furnished2012-07-31T00:00:002012-10-16T00:00:00Property and CasualtyLiabilityGeneral Liability57524Premium FinanceOrganizationINDV3564WEHMAN, GUY BOBInsuredAgent HandlingNoPremium Refunded; Information Furnished2012-07-31T00:00:002012-10-16T00:00:00Property and CasualtyLiabilityGeneral Liability224750AgentIndividualINDV3565ALLSTATE INDEMNITY COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-07-30T00:00:002012-11-24T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured167Ins Co - Licensed/ActiveOrganizationINDV3566HUMANA INSURANCE COMPANYProviderDenial Of Pymt For Emerg Care; Medical Necessity; Unsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-07-30T00:00:002012-09-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORGEMERGENCY CARE; GR-Claim Evaluation3569BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredPremium and RatingNoContract Language/Legal Issue; Information Furnished2012-07-30T00:00:002012-09-14T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationINDV3570HUMANA HEALTH PLAN OF TEXAS, INC.InsuredDelays (Claims Handling)YesInformation Furnished2012-07-30T00:00:002012-09-19T00:00:00Health Maintenance OrgAccident and HealthGroup A&HAssociated Subject Company; Insured702Ins Co - Licensed/ActiveOrganizationINDV3572ALLSTATE INDEMNITY COMPANYRelativeAssignment of BenefitsNoContract Language/Legal Issue; Company Position Upheld; Information Furnished2012-07-19T00:00:002012-09-18T00:00:00Property and CasualtyAutomobileIndividual Private PassDeceased Person; Insured167Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; POLICY EXCLUSION; UNDERWRITING CRITERIA3573STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-07-31T00:00:002012-09-20T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; HAIL3574CONNECTICUT GENERAL LIFE INSURANCE COMPANYInsuredDenial Of ClaimYesAdditional Monies Received2012-07-30T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3576UNITEDHEALTHCARE OF TEXAS, INC.ProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-27T00:00:002012-09-04T00:00:00Medicare HMOAccident and HealthGroup A&HInsured3363Health Maintenance OrgOrganizationORGGR-Claim Evaluation3577BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoCompany Position Upheld2012-07-20T00:00:002012-09-10T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG3579SAFECO INSURANCE COMPANY OF INDIANAInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferYesInformation Furnished; Additional Monies Received2012-07-31T00:00:002012-09-24T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent2496Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; DAMAGE DISPUTE; HAIL; ROOF3580STATE FARM LLOYDSInsuredDeficient Claim Notice; Delays (Claims Handling)YesAdditional Monies Received2012-07-31T00:00:002012-10-01T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; DAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF3580ALLSTATE TEXAS LLOYD'SInsuredDeficient Claim Notice; Denial Of ClaimNoCompany Position Upheld2012-07-31T00:00:002012-10-01T00:00:00Property and CasualtyHomeownersHomeowners3721Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; DAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF3581AETNA LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-07-27T00:00:002012-09-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person; Insured245Ins Co - Licensed/ActiveOrganizationORG3582SOUTHERN INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-07-27T00:00:002012-10-17T00:00:00Property and CasualtyHomeownersHomeowners1525Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; TOTAL LOSS3583NATIONWIDE LLOYDSThird PartyDenial Of Claim; Liability DisputeNoInformation Furnished; Company Position Upheld2012-07-30T00:00:002012-10-02T00:00:00Property and CasualtyLiabilityGeneral Liability870Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation3584INDEPENDENT ORDER OF FORESTERS, THERelativeCash Value; Delays (Claims Handling)NoInformation Furnished2012-07-27T00:00:002012-09-10T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeCorrespondent Person; Deceased Person13242Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3585ACCC INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeNoQuestion of Fact; Information Furnished; Company Position Upheld2012-07-30T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured9825Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3586BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoNo Jurisdiction2012-07-30T00:00:002012-09-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV3592FOREMOST INSURANCE COMPANY, GRAND RAPIDS, MICHIGANInsuredDelays (Claims Handling)NoAdditional Payment Expected2012-07-30T00:00:002012-11-02T00:00:00Property and CasualtyAutomobileIndividual Private Pass2532Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN3593CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling); Discl-Fee Schd/Clms Proc Gdlns; OtherNoInformation Furnished2012-08-03T00:00:002012-10-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3595HUMANA HEALTH PLAN OF TEXAS, INC.ProviderDelays (Claims Handling); Prompt PayNo2012-07-30T00:00:002013-04-25T00:00:00Health Maintenance OrgAccident and HealthGroup A&HAssociated Subject Company; Insured702Health Maintenance OrgOrganizationORG3595BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling); Prompt PayNoInformation Furnished2012-07-30T00:00:002013-04-25T00:00:00Health Maintenance OrgAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG3596STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoClaim Settled; Information Furnished; Additional Monies Received2012-07-30T00:00:002013-03-25T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE3599HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoClaim Settled; Additional Monies Received; Information Furnished2012-07-30T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency2362Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; TOTAL LOSS3600UNITEDHEALTHCARE INSURANCE COMPANYProviderIRO Request Not Filed TimelyNoInformation Furnished; Other2012-07-30T00:00:002012-09-24T00:00:00Utilization Review AgentAccident and HealthGroup A&HCorrespondent Person; Insured1348Ins Co - Licensed/ActiveOrganizationINDV3601HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-07-31T00:00:002012-10-01T00:00:00Property and CasualtyAutomobileIndividual Private Pass2362Ins Co - Licensed/ActiveOrganizationINDVACV; ADJUSTER'S HANDLING3602UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoInsufficient Information; Claim Settled2012-07-30T00:00:002012-09-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV3603BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling); Prompt PayNoClaim Not Clean; Contract Language/Legal Issue2012-07-30T00:00:002012-10-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG3604FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Delays (Policyholder Service)YesInformation Furnished; Question of Fact2012-07-31T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; EXAM UNDER OATH; GR-Claim Evaluation3605BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoClaim Not Clean2012-07-30T00:00:002012-09-14T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG3606ALLSTATE TEXAS LLOYD'SInsuredDenial Of Claim; Unsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-07-31T00:00:002012-09-24T00:00:00Property and CasualtyHomeownersHomeowners3721Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation3608UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-30T00:00:002012-09-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV3609ENCOMPASS INDEMNITY COMPANYThird PartyDenial Of ClaimYesCompany Position Upheld2012-07-31T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured15014Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3611HARTFORD CASUALTY INSURANCE COMPANYProviderUnsatisfactory Settle/Offer; Usual And CustomaryNoInformation Furnished; Company Position Upheld2012-07-31T00:00:002012-09-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass2381Ins Co - Licensed/ActiveOrganizationORGCHIROPRACTIC; COVERAGE DISPUTE3613ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYConsumer (Non-Insured)Use of Credit ReportsNoInformation Furnished2012-07-30T00:00:002012-10-24T00:00:00Property and CasualtyMiscellaneousNo Line Specified936Ins Co - Licensed/ActiveOrganizationINDVCREDIT REPORT3614AMERICO FINANCIAL LIFE AND ANNUITY INSURANCE COMPANYInsuredDelays (Policyholder Service)NoInformation Furnished2012-07-30T00:00:002012-10-19T00:00:00Life, Accident and HealthLife & AnnuityIRA Correspondent Person; Third Party Admin-Licensed2897Ins Co - Licensed/ActiveOrganizationINDV3614KAZDON, INC.InsuredDelays (Policyholder Service)NoNo Jurisdiction2012-07-30T00:00:002012-10-19T00:00:00Life, Accident and HealthLife & AnnuityIRA Correspondent Person; Third Party Admin-Licensed18329Third Party AdministratorsOrganizationINDV3615DRIVER'S INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoAdditional Monies Received; Claim Settled2012-07-30T00:00:002012-11-14T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2038Ins Co - Licensed/ActiveOrganizationINDVACV; GR-Claim Evaluation; TOTAL LOSS3616CAPITOL COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferYesQuestion of Fact; Information Furnished; Additional Payment Expected2012-07-30T00:00:002012-12-05T00:00:00Property and CasualtyHomeownersHomeowners2992Ins Co - Licensed/ActiveOrganizationINDVACV; DAMAGE DISPUTE; DEDUCTIBLE; DEPRECIATION; ROOF3617UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling); Timely Filing DeficiencyNoInsufficient Information2012-07-27T00:00:002012-10-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3618OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-07-30T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING3620AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-30T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG3621STATE FARM LLOYDSInsuredDenial Of Claim; Unsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-07-30T00:00:002012-09-20T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent3105Ins Co - Licensed/ActiveOrganizationINDVACV; ADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; ROOF3623NATIONAL LLOYDS INSURANCE COMPANYInsuredDenial Of ClaimYesAdditional Monies Received; Information Furnished2012-07-31T00:00:002012-09-21T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent1914Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE3625ALLSTATE INDEMNITY COMPANYInsuredUnsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished; Contract Language/Legal Issue2012-07-31T00:00:002012-10-02T00:00:00Property and CasualtyHomeownersHomeowners167Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; OVERHEAD AND PROFIT3626UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-30T00:00:002012-09-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured1348Ins Co - Licensed/ActiveOrganizationORG3627METROPOLITAN LIFE INSURANCE COMPANYProviderRecoupment Of Claims Payment; Unsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-07-27T00:00:002012-09-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured13191Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3630MUTUAL OF OMAHA INSURANCE COMPANYInsuredDelays (Underwriting); Refund Of Premium; Refusal to InsureYesInformation Furnished; Premium Refunded2012-07-27T00:00:002012-09-12T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1977Ins Co - Licensed/ActiveOrganizationINDV3631BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/Offer; Usual And CustomaryNoAdditional Monies Received; Contract Language/Legal Issue2012-07-30T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG3632DRIVER'S INSURANCE COMPANYLienholderDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; Record Only2012-07-31T00:00:002012-09-21T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Associated Subject Person; Insured2038Ins Co - Licensed/ActiveOrganizationINDVPOLICY EXCLUSION3633WELLS FARGO BANK NAInsuredOtherNoInformation Furnished; Referred To2012-07-31T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeowners67922Mortgage LenderOrganizationINDV3635BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferYesInformation Furnished; Additional Payment Expected; Contract Language/Legal Issue2012-07-27T00:00:002012-10-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company; Insured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation; GRANDFATHERED HEALTH PLAN; MULTIPLE INSUREDS3636HUMANA INSURANCE COMPANYRelativeUnsatisfactory Settle/OfferNo2012-07-23T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationINDV3636CAREMARK, L.L.C.RelativeUnsatisfactory Settle/OfferNoReferred To2012-07-23T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H56496Third Party AdministratorsOrganizationINDV3638ALLSTATE INDEMNITY COMPANYInsuredDenial Of Claim; Unsatisfactory Settle/OfferYesInformation Furnished; Additional Monies Received2012-07-30T00:00:002012-09-24T00:00:00Property and CasualtyHomeownersHomeowners167Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; DAMAGE DISPUTE; HAIL; WATER DAMAGE3639HUMANA INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-27T00:00:002012-10-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Health Maintenance OrgOrganizationORGBUNDLING; GR-Claim Evaluation3640GERBER LIFE INSURANCE COMPANYBeneficiaryDelays (Claims Handling); Delays (Policyholder Service); Misleading AdvertisingNoContract Language/Legal Issue; Information Furnished2012-07-27T00:00:002012-10-11T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person2465Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation3641TEXAS FAIR PLAN ASSOCIATIONInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-07-30T00:00:002012-09-19T00:00:00Property and CasualtyHomeownersHomeowners18208Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; DAMAGE DISPUTE; WATER DAMAGE3642PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished2012-08-01T00:00:002012-09-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DIMINISHED VALUE3643ACCC INSURANCE COMPANYLienholderDelays (Claims Handling)NoAdditional Monies Received; Information Furnished; Claim Settled2012-08-01T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private PassCorrespondent Person; Insured9825Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; TOTAL LOSS3644GUARDIAN LIFE INSURANCE COMPANY OF AMERICA, THEProviderDenial Of Claim; Medical NecessityNoAdditional Monies Received; Information Furnished2012-07-30T00:00:002012-09-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2414Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3647GRAMERCY INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received; Claim Settled; Information Furnished2012-08-01T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1062Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation3648ACCC INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling)NoClaim Settled2012-08-01T00:00:002012-09-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; TOTAL LOSS3649REASSURE AMERICA LIFE INSURANCE COMPANYRelativeDelays (Policyholder Service)NoContract Language/Legal Issue2012-07-30T00:00:002012-10-12T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured1228Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; SENIOR CITIZEN3651TIME INSURANCE COMPANYProviderDelays (Claims Handling)NoAdditional Monies Received2012-07-30T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company; Associated Subject Person; Insured1374Ins Co - Licensed/ActiveOrganizationINDV3652MIGUES, MICHAEL DInsurance CompanyAgency BalanceYesInformation Furnished2012-07-30T00:00:002012-12-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&H787859AgentIndividualORG3653DEARBORN NATIONAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoClaim Settled2012-07-30T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured1013Ins Co - Licensed/ActiveOrganizationINDV3655DEARBORN NATIONAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoClaim Settled2012-07-30T00:00:002012-08-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured1013Ins Co - Licensed/ActiveOrganizationINDV3656DEARBORN NATIONAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoClaim Settled2012-07-30T00:00:002012-08-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured1013Ins Co - Licensed/ActiveOrganizationINDV3658BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoOther; Additional Monies Received; Claim Settled2012-07-30T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationINDV3660HUMANA INSURANCE COMPANYAgentPremium and RatingNoInformation Furnished; Contract Language/Legal Issue2012-07-30T00:00:002012-10-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured Company1040Ins Co - Licensed/ActiveOrganizationINDV3661TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredCancellation; Unfair DiscriminationNoCompany Position Upheld; Information Furnished2012-07-31T00:00:002012-10-12T00:00:00Property and CasualtyHomeownersHomeowners1444Ins Co - Licensed/ActiveOrganizationINDVROOF3662BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoNo Jurisdiction2012-07-30T00:00:002012-09-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV3663NATIONAL GENERAL ASSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received2012-07-31T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileBusiness Automobile7765Ins Co - Licensed/ActiveOrganizationINDV3664DEARBORN NATIONAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoClaim Settled2012-07-30T00:00:002012-08-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured1013Ins Co - Licensed/ActiveOrganizationINDV3665BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/Offer; Usual And CustomaryYesInformation Furnished; Additional Monies Received2012-07-30T00:00:002012-10-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Correspondent Person; Insured10047Ins Co - Licensed/ActiveOrganizationORG3666ALLSTATE INDEMNITY COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld; Information Furnished2012-07-31T00:00:002012-10-05T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured167Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED3668BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredEndorsement / RiderNoContract Language/Legal Issue2012-08-10T00:00:002012-08-31T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeGR Elected Official10047Ins Co - Licensed/ActiveOrganizationINDV3669UNDERWRITERS AT LLOYD'S, LONDONPhysicianDelays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-07-30T00:00:002012-09-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured55949Ins Co - Surplus LinesOrganizationINDV3670MOLINA HEALTHCARE OF TEXAS, INC.Contracted ProviderDenial Of Claim; Ntwk Denial/Termin Of ProvNoAdditional Monies Received; Information Furnished2012-07-31T00:00:002012-10-02T00:00:00Health Maintenance OrgAccident and HealthGroup A&H23469Health Maintenance OrgOrganizationINDV3671UNITEDHEALTHCARE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferYesClaim Settled2012-07-30T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV3672HUMANA HEALTH PLAN OF TEXAS, INC.ProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-07-30T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured702Ins Co - Licensed/ActiveOrganizationORG3673AETNA LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-30T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG3674LIBERTY COUNTY MUTUAL INSURANCE COMPANYThird PartyLiability Dispute; Unsatisfactory Settle/OfferNoAdditional Monies Received; Information Furnished2012-07-30T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass3762Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE3675UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-07-30T00:00:002012-09-19T00:00:00Medicare HMOAccident and HealthIndividual A & HAssociated Subject Person; Insured1348Health Maintenance OrgOrganizationORGSENIOR CITIZEN3676HUMANADENTAL INSURANCE COMPANYProviderDelays (Claims Handling)YesAdditional Monies Received; Information Furnished2012-07-30T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured1182Ins Co - Licensed/ActiveOrganizationORG3677HUMANADENTAL INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction; Additional Monies Received2012-07-30T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured1182Third Party AdministratorsOrganizationORG3678IDS PROPERTY CASUALTY INSURANCE COMPANYInsuredAttorney Fraud; Denial Of ClaimNoQuestion of Fact; Information Furnished2012-07-30T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person3610Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE3679REASSURE AMERICA LIFE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoReferred To; Information Furnished2012-07-24T00:00:002012-11-14T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Person1228Ins Co - Licensed/ActiveOrganizationINDV3680AMERICA FIRST LLOYD'S INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Question of Fact2012-08-01T00:00:002012-09-17T00:00:00Property and CasualtyLiabilityGeneral LiabilityInsured Company17819Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; WATER DAMAGE3681AMERICAN NATIONAL INSURANCE COMPANYInsuredPremium NoticeNoCorrective Action Taken; Information Furnished2012-07-30T00:00:002012-09-04T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life135Ins Co - Licensed/ActiveOrganizationINDV3682HUMANA INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; No Jurisdiction2012-07-31T00:00:002012-09-27T00:00:00Utilization Review AgentAccident and HealthGroup A&HAssociated Subject Company; Correspondent Company1040Ins Co - Licensed/ActiveOrganizationINDV3683ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyDenial Of ClaimNoQuestion of Fact; Information Furnished; Company Position Upheld2012-08-01T00:00:002012-09-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3684AMERICAN FAMILY LIFE ASSURANCE COMPANY OF COLUMBUSInsuredDelays (Claims Handling)NoContract Language/Legal Issue2012-07-31T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2655Ins Co - Licensed/ActiveOrganizationINDV3685DELTA DENTAL INSURANCE COMPANYProviderDelays (Claims Handling)NoAdditional Monies Received; No Jurisdiction2012-07-31T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured2752Third Party AdministratorsOrganizationORG3686CONTINENTAL CASUALTY COMPANYInsuredMisleading AdvertisingNoCompany Position Upheld; Information Furnished2012-08-01T00:00:002012-12-11T00:00:00Property and CasualtyMiscellaneousMortgage GuarantyAssociated Subject Company2814Ins Co - Licensed/ActiveOrganizationINDVADVERTISING3687FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld2012-08-01T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent2623Ins Co - Licensed/ActiveOrganizationINDV3688BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONRelativeOtherNoRecord Only2012-07-30T00:00:002012-08-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured10047Ins Co - Licensed/ActiveOrganizationINDV3689BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoAdditional Monies Received; Information Furnished2012-07-31T00:00:002012-09-28T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life10047Ins Co - Licensed/ActiveOrganizationINDV3690Assist Card of FloridaProviderDelays (Claims Handling)NoClaim Settled; Additional Monies Received; No Jurisdiction2012-07-31T00:00:002012-11-15T00:00:00Property and CasualtyMiscellaneousTravelAssociated Subject Company; Correspondent Person; Insured67959OtherOrganizationORG3691SAFECO INSURANCE COMPANY OF INDIANAInsuredDelays (Claims Handling)NoCompany Position Upheld2012-08-01T00:00:002012-10-25T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent2496Ins Co - Licensed/ActiveOrganizationINDVWATER DAMAGE3692UNITEDHEALTHCARE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-31T00:00:002012-08-28T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1348Ins Co - Licensed/ActiveOrganizationINDV3693HUMANADENTAL INSURANCE COMPANYProviderDelays (Claims Handling)NoInformation Furnished; Additional Monies Received2012-07-31T00:00:002012-11-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1182Ins Co - Licensed/ActiveOrganizationORG3694UNITEDHEALTHCARE INSURANCE COMPANYRelativeUnsatisfactory Settle/OfferYesAdditional Monies Received; Information Furnished2012-07-31T00:00:002012-10-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV3695UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-31T00:00:002012-09-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person; Insured1348Ins Co - Licensed/ActiveOrganizationORG3696AETNA LIFE INSURANCE COMPANYRelativeDelays (Claims Handling)NoNo Jurisdiction2012-07-31T00:00:002012-09-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Third Party AdministratorsOrganizationINDV3697UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-31T00:00:002012-09-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348ProviderOrganizationORG3698CHESAPEAKE LIFE INSURANCE COMPANY, THEInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-08-10T00:00:002012-10-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2924Ins Co - Licensed/ActiveOrganizationINDV3699RELIABLE LIFE INSURANCE COMPANY, THEBeneficiaryUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-07-31T00:00:002012-09-12T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person1704Ins Co - Licensed/ActiveOrganizationINDV3700TIME INSURANCE COMPANYInsuredEndorsement / Rider; Premium and RatingNoInformation Furnished2012-07-30T00:00:002012-09-12T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company1374Ins Co - Licensed/ActiveOrganizationINDV3701CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-30T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationINDV3702UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimYesAdditional Monies Received; Information Furnished; Stat Pen Pd-Over 90 Dys Late2012-07-30T00:00:002012-09-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG3704OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished; Premium Refunded2012-08-01T00:00:002012-09-17T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Insured1823Ins Co - Licensed/ActiveOrganizationINDV3705FIRST AMERICAN TITLE INSURANCE COMPANYInsuredFail To Detect Pay Taxes OwedNoTaxes Paid2012-08-01T00:00:002012-09-24T00:00:00Property and CasualtyMiscellaneousTitle Insurance52569Ins Co - Licensed/ActiveOrganizationINDVTAXES3706DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling)NoCompany Position Upheld; Information Furnished2012-08-01T00:00:002012-10-27T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2038Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED3707UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-07-30T00:00:002012-09-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDVPHARMACY3708INFINITY COUNTY MUTUAL INSURANCE COMPANYInsuredRefund Of PremiumNoInformation Furnished2012-08-08T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1197Ins Co - Licensed/ActiveOrganizationINDV3709UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-08-06T00:00:002012-10-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG3710BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction2012-08-06T00:00:002012-08-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG3711CONTINENTAL CASUALTY COMPANYLienholderAssignment of Benefits; Delays (Claims Handling)YesAdditional Monies Received; Claim Settled2012-08-01T00:00:002012-11-14T00:00:00Property and CasualtyAutomobileTruckers PolicyAssociated Subject Person; Correspondent Person; Insured; Insured Company2814Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING3712MedicaidPhysicianDelays (Claims Handling)NoContract Language/Legal Issue2012-08-06T00:00:002012-08-14T00:00:00Life, Accident and HealthAccident and HealthXX-State SpecificAssociated Subject Company67252Govermental EntityOrganizationINDV3713GEICO INDEMNITY COMPANYThird PartyDenial Of Claim; Liability DisputeNoInformation Furnished; Additional Monies Received; Claim Settled2012-08-01T00:00:002012-10-21T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2785Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3714TEXAS FARM BUREAU CASUALTY INSURANCE COMPANYProviderDelays (Claims Handling)NoAdditional Monies Received; Information Furnished2011-11-21T00:00:002012-09-04T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured28440Ins Co - Licensed/ActiveOrganizationINDVCHIROPRACTIC3718AETNA LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoAdditional Monies Received; No Jurisdiction2012-07-31T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDVPHARMACY; PRESCRIPTION3718EXPRESS SCRIPTS, INC.InsuredDenial Of ClaimNoNo Jurisdiction2012-07-31T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured45455Third Party AdministratorsOrganizationINDVPHARMACY; PRESCRIPTION3718MEDCO HEALTH, L.L.C.InsuredDenial Of ClaimNoNo Jurisdiction2012-07-31T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured54629Third Party AdministratorsOrganizationINDVPHARMACY; PRESCRIPTION3719UNITED SERVICES AUTOMOBILE ASSOCIATIONThird PartyLiability DisputeNoCompany Position Upheld2012-08-01T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass1254Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3720U S LLOYDS INSURANCE COMPANYThird PartyDenial Of ClaimNoContract Language/Legal Issue2012-08-01T00:00:002012-11-12T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured3177Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; EXAM UNDER OATH; POLICY EXCLUSION3721STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Additional Monies Received; Claim Settled2012-08-01T00:00:002012-10-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF; UNCOOPERATIVE INSURED3723NATIONWIDE MUTUAL INSURANCE COMPANYThird PartyOtherNoInformation Furnished2012-08-01T00:00:002012-09-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass1937Ins Co - Licensed/ActiveOrganizationINDVCOMPARATIVE NEGLIGENCE; GR-Claim Evaluation; SUBROGATION3724OAK BROOK COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoComplainant Retained Attorney; Additional Payment Expected; Question of Fact2012-08-01T00:00:002012-09-17T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured2323Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; TOTAL LOSS3725SOUTHWEST SERVICE LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue2012-07-31T00:00:002012-10-09T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1542Ins Co - Licensed/ActiveOrganizationINDVRESCISSION3725CULLUM, LAURA ANNETTEInsuredAgent HandlingNoQuestion of Fact2012-07-31T00:00:002012-10-09T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured950735AgentIndividualINDVRESCISSION3726SCOTTSDALE INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoCompany Position Upheld; Information Furnished2012-08-01T00:00:002012-10-12T00:00:00Property and CasualtyLiabilityGeneral LiabilityCorrespondent Person; Insured Company57001Ins Co - Surplus LinesOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation; MOLD; WATER DAMAGE3728BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredBalance Billing; Usual And CustomaryNoInformation Furnished2012-07-30T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person10047Ins Co - Licensed/ActiveOrganizationINDVEMERGENCY CARE; GR-Claim Evaluation3729PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeNoInformation Furnished; Company Position Upheld; Question of Fact2012-08-01T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1708Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3730AMERICAN GENERAL LIFE INSURANCE COMPANYRelativeDelays (Claims Handling)NoInformation Furnished2012-07-30T00:00:002012-10-18T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person152Ins Co - Licensed/ActiveOrganizationINDV3732OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-08-01T00:00:002012-11-02T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED3734EQUITABLE LIFE AND CASUALTY INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished2012-07-30T00:00:002012-10-13T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2688Ins Co - Licensed/ActiveOrganizationINDV3735BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/Offer; Usual And CustomaryNoContract Language/Legal Issue; Additional Monies Received2012-07-30T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG3736CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling); Timely Filing DeficiencyNoNo Jurisdiction2012-07-30T00:00:002012-09-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3737PRIMERICA LIFE INSURANCE COMPANYInsuredDelays (Policyholder Service)NoInformation Furnished2012-07-30T00:00:002012-10-04T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2114Ins Co - Licensed/ActiveOrganizationINDV3739GLOBE LIFE AND ACCIDENT INSURANCE COMPANYRelativeDelays (Policyholder Service); OtherNoInformation Furnished2012-07-30T00:00:002012-10-09T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured917Ins Co - Licensed/ActiveOrganizationINDV3741CONNECTICUT GENERAL LIFE INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling)NoNo Jurisdiction2012-07-30T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3742AETNA LIFE INSURANCE COMPANYProviderDenial Of Pymt For Emerg Care; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-30T00:00:002012-09-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3743PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Policyholder Service)NoInformation Furnished2012-08-01T00:00:002012-09-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVLOSS OF USE3743LIBERTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoAdditional Monies Received2012-08-01T00:00:002012-09-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass2210Ins Co - Licensed/ActiveOrganizationINDVLOSS OF USE3744ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyCust Service Claim Handling; Denial Of ClaimNoCompany Position Upheld; Question of Fact2012-07-27T00:00:002012-10-04T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured936Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3746RELIABLE LIFE INSURANCE COMPANY, THERelativeDelays (Policyholder Service); OtherNoInformation Furnished2012-07-30T00:00:002012-09-14T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Person; Insured1704Ins Co - Licensed/ActiveOrganizationINDV3747GOLDEN RULE INSURANCE COMPANYInsuredPPACA-Premium Rate IncreaseNoContract Language/Legal Issue2012-08-02T00:00:002012-12-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1057Ins Co - Licensed/ActiveOrganizationINDVFEDERAL HEALTH CARE REFORM3749SAFECO INSURANCE COMPANY OF INDIANAInsuredCancellation; Refund Of PremiumNoInformation Furnished2012-08-02T00:00:002012-11-20T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company2496Ins Co - Licensed/ActiveOrganizationINDV3749TEXAS WASATCH INSURANCE SERVICES, L PInsuredAgent HandlingNoPremium Refunded2012-08-02T00:00:002012-11-20T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company20058Insurance AgencyOrganizationINDV3751STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled; Information Furnished2012-08-02T00:00:002012-09-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV3755LOYA INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-08-02T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured15643Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; LOSS OF USE3756AMICA MUTUAL INSURANCE COMPANYThird PartyCust Service Claim Handling; Denial Of ClaimNoInformation Furnished; Question of Fact2012-08-02T00:00:002012-09-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass3532Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation3757UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-07-30T00:00:002012-09-06T00:00:00Medicare HMOAccident and HealthGroup A&HAssociated Subject Company; Insured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation; SENIOR CITIZEN3758PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished2012-08-02T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DEDUCTIBLE; DIMINISHED VALUE; HAIL3759OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYAttorneyDenial Of ClaimNoContract Language/Legal Issue2012-08-02T00:00:002012-09-18T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationORG3760SOUTHERN COUNTY MUTUAL INSURANCE COMPANYRelativeDenial Of ClaimNoCompany Position Upheld2012-08-02T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured1583Ins Co - Licensed/ActiveOrganizationINDV3761AMERICAN RISK INSURANCE COMPANY, INC.InsuredDelays (Claims Handling)NoAdditional Monies Received; Claim Settled; Information Furnished2012-08-02T00:00:002012-10-30T00:00:00Property and CasualtyHomeownersHomeowners27377Ins Co - Licensed/ActiveOrganizationINDV3762DRIVER'S INSURANCE COMPANYLienholderDelays (Claims Handling)YesInformation Furnished; Additional Monies Received2012-08-02T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured2038Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; TOTAL LOSS3763TEXAS STAR NETWORK/COVENTRYInjured EmployeePrimary Care Providr SelectionNoQuestion of Fact2012-07-25T00:00:002012-09-27T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Person55311WC Healthcare Provider NtwkOrganizationINDV3764VISION INSURANCE COMPANYAttorneyDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue; Company Position Upheld2012-08-02T00:00:002012-10-27T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Correspondent Person; Insured23478Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation; NAMED DRIVER POLICY3765TEXAS CHILDREN'S HEALTH PLAN, INC.Contracted ProviderRecoupment Of Claims PaymentNoAdditional Monies Received; No Jurisdiction; Information Furnished2012-08-01T00:00:002012-11-08T00:00:00Health Maintenance OrgAccident and HealthXX-State SpecificInsured8237Health Maintenance OrgOrganizationINDV3766AETNA LIFE INSURANCE COMPANYProviderTimely Filing Deficiency; Unsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-07-20T00:00:002012-10-18T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured245Self-Funded / ErisaOrganizationINDVGR-Claim Evaluation3766AETNA HEALTH INC.ProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-07-20T00:00:002012-10-18T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured3522Health Maintenance OrgOrganizationINDVGR-Claim Evaluation3767COLONIAL COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoAdditional Payment Expected; Question of Fact; Information Furnished2012-08-02T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass2455Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation3768UNITEDHEALTHCARE INSURANCE COMPANYInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferNoInformation Furnished2012-08-01T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV3768Atlas Anesthesia AssociatesInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-01T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H75322ProviderOrganizationINDV3769OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredRefund Of PremiumNoCompany Position Upheld; Information Furnished2012-08-02T00:00:002012-11-23T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Associated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDV3770OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Question of Fact2012-08-02T00:00:002012-10-18T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3771OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYConsumer (Non-Insured)Delays (Claims Handling)NoInformation Furnished; Additional Payment Expected2012-08-02T00:00:002012-10-10T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationORGLOSS OF USE; TOTAL LOSS3772CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-01T00:00:002012-11-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Self-Funded / ErisaOrganizationORG3773FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoCompany Position Upheld; Information Furnished2012-08-02T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent2623Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING3774AMERICAN BANKERS INSURANCE COMPANY OF FLORIDAInsuredDenial Of Claim; Refund Of PremiumYesPremium Refunded2012-08-02T00:00:002012-11-05T00:00:00Property and CasualtyMiscellaneousWarranty ContractAssociated Subject Agency176Ins Co - Licensed/ActiveOrganizationINDV3775UNITED CONCORDIA INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction; Information Furnished; Additional Monies Received2012-07-31T00:00:002012-10-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured3624Ins Co - Licensed/ActiveOrganizationORG3776GATES, LARRY ALANInsuredAgent Handling; ConversionYesPremium Refunded; Referred for Disciplinary Actn2012-08-02T00:00:002012-10-24T00:00:00Property and CasualtyHomeownersHomeowners121041AgentIndividualINDV3777COLONIAL COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld; Policy Not In Force2012-08-02T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass2455Ins Co - Licensed/ActiveOrganizationINDV3778UNITED SERVICES AUTOMOBILE ASSOCIATIONRelativeCust Service Claim Handling; Delays (Claims Handling)NoNo Jurisdiction2012-08-02T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured1254Ins Co - Licensed/ActiveOrganizationINDVACV; TOTAL LOSS3779TRAVELERS LLOYDS OF TEXAS INSURANCE COMPANYThird PartyDenial Of ClaimNoQuestion of Fact2012-08-02T00:00:002012-09-26T00:00:00Property and CasualtyHomeownersHomeownersInsured776Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; ROOF; SENIOR CITIZEN3780HEALTHFIRST TPA, INC.ProviderUnsatisfactory Settle/OfferNoOther; Information Furnished; Record Only2012-08-01T00:00:002012-12-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured44234Third Party AdministratorsOrganizationORG3781OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredRefund Of PremiumYesPremium Refunded2012-08-02T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDV3781PLS INSURANCE OF TEXAS, INC.InsuredRefund Of PremiumYesPremium Refunded; Information Furnished2012-08-02T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass44686Insurance AgencyOrganizationINDV3784UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-08-01T00:00:002012-10-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG3785HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished2012-08-02T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency2362Ins Co - Licensed/ActiveOrganizationINDV3785TUNNELL, STEPHEN WESLEY JRInsuredRefund Of PremiumYesOther2012-08-02T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency70528AgentIndividualINDV3786BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-31T00:00:002012-10-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Third Party AdministratorsOrganizationORG3788NATIONAL LLOYDS INSURANCE COMPANYConsumer (Non-Insured)Unsatisfactory Settle/OfferNoClaim Settled; Additional Monies Received2012-08-02T00:00:002012-10-30T00:00:00Property and CasualtyHomeownersHomeowners1914Ins Co - Licensed/ActiveOrganizationINDVACV; ADJUSTER'S HANDLING; DEPRECIATION3789BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONConsumer (Non-Insured)Cancellation; Refusal to InsureYesPremium Refunded; Contract Language/Legal Issue2012-08-01T00:00:002012-10-12T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured10047Ins Co - Licensed/ActiveOrganizationINDV3790COLONIAL COUNTY MUTUAL INSURANCE COMPANYInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferNoAdditional Monies Received2012-08-02T00:00:002012-11-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass2455Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; TOTAL LOSS3790LEWIS, JOSHUA LEEInsuredAgent HandlingNoInformation Furnished2012-08-02T00:00:002012-11-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass287343AgentIndividualINDVADJUSTER'S HANDLING; GR-Claim Evaluation; TOTAL LOSS3791MEDCO HEALTH, L.L.C.InsuredCust Service Claim Handling; Unsatisfactory Settle/OfferYesInformation Furnished; Additional Monies Received; Corrective Action Taken2012-08-01T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&H54629Ins Co - Licensed/ActiveOrganizationINDVPRESCRIPTION3793NATIONWIDE MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld2012-08-01T00:00:002012-11-21T00:00:00Property and CasualtyLiabilityGeneral Liability1937Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3793JOHN T CLARK AGENCY, LLCInsuredMisrepresentationNoQuestion of Fact2012-08-01T00:00:002012-11-21T00:00:00Property and CasualtyLiabilityGeneral Liability29768Insurance AgencyOrganizationORGGR-Claim Evaluation3795RELIABLE LIFE INSURANCE COMPANY, THERelativeDelays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-08-01T00:00:002012-09-17T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person1704Ins Co - Licensed/ActiveOrganizationINDV3796GOLDEN RULE INSURANCE COMPANYInsuredExcessive Rates; Premium and RatingNoRate Problem Resolved; Earnest Money Paid Out2012-08-01T00:00:002012-09-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1057Ins Co - Licensed/ActiveOrganizationINDV3797BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONConsumer (Non-Insured)Dependent CoverageNoNo Jurisdiction2012-08-01T00:00:002012-09-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV3798UNITEDHEALTHCARE INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-08-01T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company1348Self-Funded / ErisaOrganizationINDV3799NATIONAL LLOYDS INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld2012-07-31T00:00:002012-11-21T00:00:00Property and CasualtyHomeownersHomeowners1914Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; ROOF3800BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONOtherPrompt Pay; Unsatisfactory Settle/OfferYesInformation Furnished; Clean Claims Violation; Claim Not Clean2012-07-31T00:00:002013-03-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3801FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYAttorneyCust Service Claim Handling; Delays (Claims Handling)NoInformation Furnished2012-07-31T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2623Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING3802MCDANIEL, MILTON EARLInsurance CompanyConversionYesOther2012-07-27T00:00:002012-10-15T00:00:00Property and CasualtyMiscellaneousP & C Misc29677AgentIndividualORG3803BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderBalance Billing; Denial Of Pymt For Emerg Care; Medical Necessity; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-30T00:00:002012-09-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationORGEMERGENCY CARE; GR-Claim Evaluation3804USAA TEXAS LLOYD'S COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-08-09T00:00:002012-09-17T00:00:00Property and CasualtyHomeownersHomeowners14630Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; EXAM UNDER OATH; GR-Claim Evaluation; HAIL; ROOF; UNCOOPERATIVE INSURED; WATER DAMAGE3805UNITEDHEALTHCARE INSURANCE COMPANYProviderRecoupment Of Claims Payment; SB418 Rule ViolationNoNo Jurisdiction2012-07-30T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3807LAWYERS TITLE INSURANCE CORPORATIONInsuredOtherNoCompany Position Upheld2012-07-31T00:00:002012-10-11T00:00:00Property and CasualtyMiscellaneousTitle Insurance48663Ins Co - Licensed/ActiveOrganizationINDV3808BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderRecoupment Of Claims Payment; SB418 Rule ViolationNoInsufficient Information2012-07-30T00:00:002012-08-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3809CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoAdditional Payment Expected2012-08-08T00:00:002012-09-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationINDV3810UNITEDHEALTHCARE INSURANCE COMPANYProviderRecoupment Of Claims Payment; SB418 Rule ViolationNoNo Jurisdiction2012-07-30T00:00:002012-09-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3811AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-08T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDVCHIROPRACTIC3813CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-08T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationINDVCHIROPRACTIC3814SECURITY NATIONAL INSURANCE COMPANYProviderDelays (Claims Handling)NoInsufficient Information2012-08-10T00:00:002012-12-11T00:00:00Property and CasualtyAccident and HealthIndividual A & HAssociated Subject Person1598Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3815OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received; Additional Payment Expected2011-04-28T00:00:002012-11-20T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDV3816AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-30T00:00:002012-09-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG3817MOLINA HEALTHCARE OF TEXAS, INC.Third PartyRecoupment Of Claims Payment; SB418 Rule ViolationNoNo Jurisdiction; Information Furnished2012-07-30T00:00:002012-10-15T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Person; Insured23469Health Maintenance OrgOrganizationORG3820ACCC INSURANCE COMPANYOtherDenial Of ClaimYesClaim Settled; Information Furnished2012-08-09T00:00:002012-10-01T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured9825Ins Co - Licensed/ActiveOrganizationINDVTOTAL LOSS3821HOME STATE COUNTY MUTUAL INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)NoInformation Furnished; Contract Language/Legal Issue2012-07-31T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency2362Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; LOSS OF USE; TOTAL LOSS; UNCOOPERATIVE INSURED3822UNITEDHEALTHCARE INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Additional Payment Expected2012-08-02T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company1348Ins Co - Licensed/ActiveOrganizationINDV3824GOLDEN RULE INSURANCE COMPANYInsuredCancellationNoCancel/Non-Renewal Upheld; Information Furnished2012-07-31T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1057Ins Co - Licensed/ActiveOrganizationINDV3825OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-07-30T00:00:002012-10-02T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation3826HOUSEHOLD LIFE INSURANCE COMPANYInsuredRefund Of PremiumYesPremium Refunded; Additional Monies Received2012-08-02T00:00:002012-10-30T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life3713Ins Co - Licensed/ActiveOrganizationINDV3827SLAYTON, JAMES DOYLEAgentAgency BalanceYesInformation Furnished2012-07-31T00:00:002012-10-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&H916699AgentIndividualORG3828CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction; Additional Monies Received2012-08-02T00:00:002012-09-07T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured25422Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN3830MCCURDY, LISA RAVONNEAgentAgency BalanceYesInformation Furnished2012-07-27T00:00:002012-10-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&H860028AgentIndividualORG3831NICHOLS, LESKEL DONTAAgentAgency BalanceYesInformation Furnished2012-07-27T00:00:002012-10-21T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life718917AgentIndividualORG3832ETHERIDGE, WILLIE H JRAgentAgency BalanceYesInformation Furnished2012-07-31T00:00:002012-10-11T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life540714Ins Co - Licensed/ActiveIndividualORG3834CARTER, JOCQUELINE LOLETHAAgentUnauthorized ActsYesInformation Furnished2012-07-31T00:00:002012-10-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&H530804AgentIndividualORG3835TRUJILLO, RENEAgentAgency BalanceYesInformation Furnished2012-07-31T00:00:002012-10-05T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life862537Ins Co - Licensed/ActiveIndividualORG3836UNITEDHEALTHCARE INSURANCE COMPANYRelativeDelays (Policyholder Service); Refund Of PremiumYesNo Jurisdiction; Failure to Timely Respond2012-08-10T00:00:002012-10-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV3837ONSERIO, JOSEPH TIRIMBAAgentAgency BalanceYesInformation Furnished2012-07-27T00:00:002012-10-21T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life910587AgentIndividualORG3838STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoQuestion of Fact; Claim Settled2012-08-01T00:00:002012-09-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVACV; HAIL; TOTAL LOSS3839AMERICAN GENERAL LIFE INSURANCE COMPANYAgentDelays (Policyholder Service)NoCompany Position Upheld; Contract Language/Legal Issue2012-08-10T00:00:002012-09-28T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured152Ins Co - Licensed/ActiveOrganizationINDV3841CONNECTICUT GENERAL LIFE INSURANCE COMPANYInsuredDelays (Policyholder Service); Delays In AuthorizationNoContract Language/Legal Issue; Information Furnished2012-08-13T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HGR Elected Official2851Ins Co - Licensed/ActiveOrganizationINDV3843BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredCust Service Claim HandlingNoInformation Furnished2012-08-02T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationINDV3845CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Additional Payment Expected2012-08-02T00:00:002012-09-06T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured25422Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN3847GOLDEN RULE INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished2012-08-02T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1057Ins Co - Licensed/ActiveOrganizationINDV3854AETNA LIFE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-02T00:00:002012-10-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDV3854UNITED BEHAVIORAL HEALTHInsuredUnsatisfactory Settle/OfferNoOther2012-08-02T00:00:002012-10-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured44243Third Party AdministratorsOrganizationINDV3855UNITEDHEALTHCARE INSURANCE COMPANYInsuredSB418 Rule Violation; Unsatisfactory Settle/OfferYesAdditional Monies Received; Information Furnished2012-08-02T00:00:002012-10-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person1348Ins Co - Licensed/ActiveOrganizationINDV3856WESTERN SURETY COMPANYInsuredOtherNoRecord Only2012-08-03T00:00:002012-10-23T00:00:00Property and CasualtyMiscellaneousFidelity & Surety1163Ins Co - Licensed/ActiveOrganizationORG3857BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction2012-08-02T00:00:002012-10-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG3859SELECT BENEFITS GROUP, INC.InsuredDelays (Claims Handling)NoAdditional Monies Received; Contract Language/Legal Issue2012-08-02T00:00:002013-02-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&H18581Third Party AdministratorsOrganizationINDV3860UNITEDHEALTHCARE INSURANCE COMPANYContracted ProviderDelays (Claims Handling); SB418 Rule ViolationYesAdditional Monies Received; Information Furnished; Claim Not Clean2012-08-02T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person; Insured1348Ins Co - Licensed/ActiveOrganizationORG3862UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesInformation Furnished; Other2012-08-01T00:00:002012-10-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV3864UNIVERSAL NORTH AMERICA INSURANCE COMPANYInsuredCancellation; Refusal to InsureYesInformation Furnished; Non-Renewal Rescinded2012-08-02T00:00:002012-09-12T00:00:00Property and CasualtyHomeownersHomeowners23526Ins Co - Licensed/ActiveOrganizationINDV3865ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICAInsuredCash Value; Delays (Policyholder Service)NoContract Language/Legal Issue; Information Furnished2012-08-02T00:00:002012-11-02T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesAssociated Subject Company910Ins Co - Licensed/ActiveOrganizationINDV3867UNIVERSAL NORTH AMERICA INSURANCE COMPANYInsuredCancellationNoPolicy Issued/Restored2012-08-02T00:00:002012-10-05T00:00:00Property and CasualtyHomeownersHomeowners23526Ins Co - Licensed/ActiveOrganizationINDV3869USAA GENERAL INDEMNITY COMPANYThird PartyOtherNoInformation Furnished2012-08-02T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured1276Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; LOSS OF USE; REPLACEMENT VEHICLE; UNCOOPERATIVE INSURED3869OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)YesAdditional Monies Received; Information Furnished2012-08-02T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; LOSS OF USE; REPLACEMENT VEHICLE; UNCOOPERATIVE INSURED3870HUMANA INSURANCE COMPANYProviderRecoupment Of Claims PaymentYesAdditional Monies Received; Information Furnished2012-08-01T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person; Insured1040Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN3872CIGNA HEALTHCARE OF TEXAS, INC.Non-Contracted ProviderOtherNoInformation Furnished2012-08-02T00:00:002012-10-30T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Person; Insured8294Health Maintenance OrgOrganizationORG3873FARMERS INSURANCE EXCHANGEInsuredDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; Company Position Upheld2012-08-02T00:00:002012-10-15T00:00:00Property and CasualtyHomeownersHomeowners2668Hospital / Doctor / DentistOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF3876BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONThird PartyDelays (Claims Handling); SB418 Rule ViolationNoClaim Not Clean; Information Furnished2012-08-01T00:00:002012-10-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG3878Health & Life AssociatesConsumer (Non-Insured)Agent HandlingNoInformation Furnished2012-07-26T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company68051Insurance AgencyOrganizationINDV3881SUPERIOR HEALTHPLAN, INC.Contracted ProviderCust Service Claim Handling; Medical NecessityNoInformation Furnished; No Jurisdiction2012-07-31T00:00:002012-10-25T00:00:00Health Maintenance OrgAccident and HealthGroup A&HAssociated Subject Company; Insured10198Health Maintenance OrgOrganizationORG3883BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-31T00:00:002012-10-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG3885CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-07-31T00:00:002012-12-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured2851Self-Funded / ErisaOrganizationORG3885FREEDOM LIFE INSURANCE COMPANY OF AMERICAProviderUnsatisfactory Settle/OfferNoClaim Settled2012-07-31T00:00:002012-12-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured2855Ins Co - Licensed/ActiveOrganizationORG3887BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished2012-07-31T00:00:002012-09-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3894METROPOLITAN LIFE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-07-31T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&H13191Ins Co - Licensed/ActiveOrganizationINDV3896CONTINENTAL CASUALTY COMPANYThird PartyDenial Of Claim; Liability DisputeNoInformation Furnished; Claim Settled2012-07-31T00:00:002012-11-20T00:00:00Property and CasualtyAutomobileBusiness AutomobileAssociated Subject Person; Insured Company2814Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation3898CELTIC INSURANCE COMPANYInsuredRefund Of PremiumNoInformation Furnished; Premium Refunded2012-07-31T00:00:002012-09-28T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life93Ins Co - Licensed/ActiveOrganizationINDV3900BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction2012-07-31T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured10047Ins Co - Licensed/ActiveOrganizationORG3905AMERICAN GENERAL LIFE INSURANCE COMPANYInsuredCancellation; Premium and RatingNoInformation Furnished; Cancellation Withdrawn2012-08-01T00:00:002012-10-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life152Ins Co - Licensed/ActiveOrganizationINDV3906BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferYesClaim Settled2012-08-02T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company10047Ins Co - Licensed/ActiveOrganizationINDV3908UNIFIED LIFE INSURANCE COMPANYInsuredMisrepresentationNoInformation Furnished2012-08-13T00:00:002012-10-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&H14633Ins Co - Licensed/ActiveOrganizationINDVCANCER3908BLUSEWICZ, LAWRENCE MICHAELInsuredMisrepresentationNoQuestion of Fact; Information Furnished2012-08-13T00:00:002012-10-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&H969064AgentIndividualINDVCANCER3915PRUDENTIAL INSURANCE COMPANY OF AMERICA, THEGR Other Government OfficeCancellationNoInformation Furnished; Contract Language/Legal Issue2012-08-15T00:00:002012-10-11T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured1729Ins Co - Licensed/ActiveOrganizationINDV3921LIFE INSURANCE COMPANY OF NORTH AMERICAOtherDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-09-10T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2157Ins Co - Licensed/ActiveOrganizationINDV3932UNITEDHEALTHCARE INSURANCE COMPANYInsuredDelays (Claims Handling)NoPremium Refunded; Contract Language/Legal Issue; Information Furnished2012-08-02T00:00:002012-09-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person1348Ins Co - Licensed/ActiveOrganizationINDV3933HUMANA HEALTH PLAN OF TEXAS, INC.Contracted ProviderDenial Of ClaimNoAdditional Monies Received2012-08-01T00:00:002012-11-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured702Ins Co - Licensed/ActiveOrganizationORG3934HUMANA INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-08-01T00:00:002012-11-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORG3935STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYAttorneyDelays (Claims Handling); Unsatisfactory Settle/OfferNoClaim Settled2012-08-08T00:00:002012-12-05T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured1510Ins Co - Licensed/ActiveOrganizationINDV3936UNUM LIFE INSURANCE COMPANY OF AMERICAInsuredPremium and RatingNoInformation Furnished2012-08-01T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1327Ins Co - Licensed/ActiveOrganizationINDV3937COLONIAL COUNTY MUTUAL INSURANCE COMPANYInsuredUsual And CustomaryNo2012-08-13T00:00:002012-11-02T00:00:00Property and CasualtyAutomobileIndividual Private Pass2455Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE3937Public Auto Sales Inc. Et. Al.InsuredUnauthorized Acts; XX-Usual, Cstmry, Rsnable ChgsYesApparent Unlicensed Activity; Referred for Disciplinary Actn2012-08-13T00:00:002012-11-02T00:00:00Property and CasualtyAutomobileIndividual Private Pass66357Insurance AgencyOrganizationINDVDEDUCTIBLE3938BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONOtherDelays (Claims Handling); Prompt PayNoClaim Not Clean; Insufficient Information2012-07-31T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG3939AMERICAN GENERAL LIFE AND ACCIDENT INSURANCE COMPANYInsuredRefund Of PremiumNoInformation Furnished2012-08-01T00:00:002012-09-28T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1967Ins Co - Licensed/ActiveOrganizationINDV3941BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoInformation Furnished2012-07-31T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG3943JOHN ALDEN LIFE INSURANCE COMPANYRelativeCash ValueNoInformation Furnished2012-07-31T00:00:002012-09-28T00:00:00Life, Accident and HealthLife & AnnuityCredit LifeAssociated Subject Company; Correspondent Person; Deceased Person2495Ins Co - Licensed/ActiveOrganizationINDV3945AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-07-31T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured245Ins Co - Licensed/ActiveOrganizationORG3946UNIVERSAL INSURANCE COMPANY OF NORTH AMERICAInsuredNon-RenewalNoCancel/Non-Renewal Upheld; Information Furnished2012-08-02T00:00:002012-10-27T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency36359Ins Co - Licensed/ActiveOrganizationINDVWATER DAMAGE3947GLOBE LIFE AND ACCIDENT INSURANCE COMPANYConsumer (Non-Insured)Delays (Claims Handling)NoContract Language/Legal Issue2012-08-01T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HCorrespondent Company; Insured917Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN3948BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderPrompt PayNoInformation Furnished; Company Position Upheld2012-07-31T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG3950UNITEDHEALTHCARE INSURANCE COMPANYRelativeDelays (Claims Handling); Denial Of ClaimNoNo Jurisdiction2012-08-02T00:00:002012-09-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured1348Ins Co - Licensed/ActiveOrganizationINDV3951MONUMENTAL LIFE INSURANCE COMPANYBeneficiaryCash ValueNoInsufficient Information2012-08-01T00:00:002012-09-11T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person2010Ins Co - Licensed/ActiveOrganizationINDV3952SAGICOR LIFE INSURANCE COMPANYRelativeDelays (Policyholder Service)NoInformation Furnished2012-08-02T00:00:002012-10-16T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person147Ins Co - Licensed/ActiveOrganizationINDV3953OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received; Company Position Upheld; Information Furnished2012-08-02T00:00:002012-10-05T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Correspondent Person1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; REPLACEMENT VEHICLE; TOTAL LOSS3955TEXAS HEALTHSPRING, LLCProviderDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; No Jurisdiction2012-08-02T00:00:002012-10-10T00:00:00Medicare HMOAccident and HealthGroup A&HInsured18634Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN3956BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling); Denial Of ClaimNoNo Jurisdiction2012-08-02T00:00:002012-09-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG3957BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONPhysicianDelays (Claims Handling)NoNo Jurisdiction2012-08-02T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV3959CIGNA HEALTH AND LIFE INSURANCE COMPANYInsuredDelays (Claims Handling)NoNo Jurisdiction2012-07-31T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1841Ins Co - Licensed/ActiveOrganizationINDV3960NORTH AMERICAN SPECIALTY INSURANCE COMPANYThird PartyDeficient Claim Notice; Delays (Claims Handling)NoAdditional Payment Expected; Contract Language/Legal Issue2012-08-02T00:00:002012-11-23T00:00:00Property and CasualtyMiscellaneousFidelity & Surety3313Ins Co - Licensed/ActiveOrganizationINDV3961BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderAccess to Care; Den/N-Pymt MD Nec Trmt N-EmrgNoCompany Position Upheld2012-08-01T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG3962SOUTHWEST SERVICE LIFE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-08-02T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company1542Ins Co - Licensed/ActiveOrganizationINDV3963CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-02T00:00:002012-09-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORG3964UNITEDHEALTHCARE INSURANCE COMPANYInsuredDen/N-Pymt MD Nec RX; Medical NecessityNo2012-08-01T00:00:002012-09-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDVPHARMACY; PRESCRIPTION3964MEDCO HEALTH, L.L.C.InsuredOverchargesNoNo Jurisdiction2012-08-01T00:00:002012-09-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&H54629Ins Co - Licensed/ActiveOrganizationINDVPHARMACY; PRESCRIPTION3966BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderPrompt Pay; SB418 Rule Violation; Unsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-07-31T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company; Insured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3967FARMERS NEW WORLD LIFE INSURANCE COMPANYInsuredAgent HandlingYesFailure to Timely Respond; Additional Monies Received2012-08-02T00:00:002012-11-07T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2622Ins Co - Licensed/ActiveOrganizationINDV3967HERING, ELEUTERIA SANDRAInsuredAgent HandlingYesQuestion of Fact2012-08-02T00:00:002012-11-07T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life307372AgentIndividualINDV3969CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANYProviderDelays (Claims Handling); SB418 Rule ViolationNoInformation Furnished; No Jurisdiction2012-08-02T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured25422Ins Co - Licensed/ActiveOrganizationORGMEDICARE PART D; PRESCRIPTION3973BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling); Denial Of ClaimNoNo Jurisdiction2012-08-02T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG3974ARCADIAN HEALTH PLAN, INC.ProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-08-02T00:00:002013-02-11T00:00:00Medicare HMOAccident and HealthIndividual A & HCorrespondent Person; Insured22588Health Maintenance OrgOrganizationORGSENIOR CITIZEN3975TEXAS ASSOCIATION OF SCHOOL BOARDS, INC.Injured EmployeeDelays (Policyholder Service); Den/N-Pymt MD Nec Trmt N-EmrgNoNo Jurisdiction2012-08-17T00:00:002012-09-17T00:00:00Life, Accident and HealthMiscellaneousWorkers' Compensation NtwkAssociated Subject Person32580WC Healthcare Provider NtwkOrganizationINDVADJUSTER'S HANDLING3976CONNECTICUT GENERAL LIFE INSURANCE COMPANYInsuredRecoupment Of Claims PaymentNoNo Jurisdiction2012-08-02T00:00:002012-11-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Self-Funded / ErisaOrganizationINDV3977ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyDenial Of ClaimNoQuestion of Fact2012-08-17T00:00:002012-09-04T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation3978CONTINENTAL CASUALTY COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Company Position Upheld2012-08-01T00:00:002012-12-13T00:00:00Property and CasualtyLiabilityGeneral LiabilityAssociated Subject Company; Associated Subject Person; Insured Company2814Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING3979CENTRAL STATES HEALTH & LIFE CO. OF OMAHARelativeCust Service Claim Handling; Delays (Claims Handling)NoClaim Settled2012-08-17T00:00:002012-09-28T00:00:00Life, Accident and HealthLife & AnnuityCredit LifeDeceased Person; GR Elected Official2909Ins Co - Licensed/ActiveOrganizationINDV3980HUMANA INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-07-31T00:00:002012-11-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation3982SAFECO LLOYDS INSURANCE COMPANYInsuredDelays (Claims Handling)NoAdditional Monies Received; Claim Settled; Information Furnished2012-07-31T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass3223Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING3983PHYSICIANS HEALTH CHOICE OF TEXAS, LLCRelativeDenial Of ClaimNoNo Jurisdiction2012-08-01T00:00:002012-09-18T00:00:00Medicare HMOAccident and HealthGroup A&HInsured17170Health Maintenance OrgOrganizationINDVSENIOR CITIZEN3984HUMANA INSURANCE COMPANYOtherPrompt Pay; Unsatisfactory Settle/OfferNoClaim Not Clean; Contract Language/Legal Issue2012-08-01T00:00:002012-11-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORG3987Tide Construction CompanyAgentUnauthorized ActsYesInformation Furnished2012-07-31T00:00:002012-11-06T00:00:00Property and CasualtyHomeownersHomeownersCorrespondent Company; Insured74112OtherOrganizationINDV3988DELTA DENTAL INSURANCE COMPANYProviderCust Service Claim HandlingNoInformation Furnished2012-08-02T00:00:002012-09-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&H33249Ins Co - Licensed/ActiveOrganizationINDV3990BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of Claim; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-03T00:00:002012-10-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Self-Funded / ErisaOrganizationINDV3991REPUBLIC LLOYDSInsuredOtherNoInformation Furnished2012-08-02T00:00:002012-09-18T00:00:00Property and CasualtyHomeownersHomeowners2299Ins Co - Licensed/ActiveOrganizationINDVROOF3993ALAMO TITLE INSURANCEInsuredDelays (Policyholder Service)YesPolicy Issued/Restored2012-08-02T00:00:002012-08-28T00:00:00Property and CasualtyMiscellaneousTitle Insurance51821Ins Co - Licensed/ActiveOrganizationINDV3994HUMANA INSURANCE COMPANYInsuredEndorsement / RiderNoContract Language/Legal Issue2012-08-03T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1040Ins Co - Licensed/ActiveOrganizationINDV3995STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYProviderDelays (Claims Handling)NoCompany Position Upheld2012-08-02T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationORG3996BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONRelativeUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-08-02T00:00:002012-10-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV3997TRAVELERS INDEMNITY COMPANY OF AMERICA, THEThird PartyDenial Of ClaimNoInformation Furnished2012-08-02T00:00:002012-09-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass1344Ins Co - Licensed/ActiveOrganizationINDV3999HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Liability DisputeYesCorrective Action Taken2012-08-02T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency2362Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation4000COLUMBIA LLOYDS INSURANCE COMPANYAgentCancellation; Refund Of PremiumNoCompany Position Upheld2012-08-02T00:00:002012-10-24T00:00:00Property and CasualtyHomeownersHomeowners3329Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE4001OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferYesQuestion of Fact; Additional Payment Expected2012-08-02T00:00:002012-11-19T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; LOSS OF USE4004NATIONAL LLOYDS INSURANCE COMPANYInsuredDenial Of ClaimNoClaim Settled; Information Furnished; Additional Monies Received2012-08-02T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeowners1914Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; WATER DAMAGE4005AETNA LIFE INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished; No Jurisdiction2012-08-02T00:00:002012-09-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV4006TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredPremium and RatingNoCompany Position Upheld2012-08-02T00:00:002012-10-11T00:00:00Property and CasualtyHomeownersHomeowners Group1444Ins Co - Licensed/ActiveOrganizationINDV4006GEICO GENERAL INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished2012-08-02T00:00:002012-10-11T00:00:00Property and CasualtyHomeownersHomeowners Group2684Ins Co - Licensed/ActiveOrganizationINDV4007ALLSTATE INDEMNITY COMPANYProviderDelays (Claims Handling)NoInformation Furnished2012-08-02T00:00:002012-12-05T00:00:00Property and CasualtyAutomobileIndividual Private Pass167Ins Co - Licensed/ActiveOrganizationORG4009LOYA INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoClaim Settled; Additional Monies Received; Information Furnished2012-08-02T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured15643Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; LOSS OF USE; SUPPLEMENTARY PAYMENT4011BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling); SB418 Rule Violation; Usual And CustomaryYesInformation Furnished; Additional Monies Received2012-08-02T00:00:002012-10-22T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4013ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld2012-08-02T00:00:002012-09-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE4014SAFECO INSURANCE COMPANY OF INDIANAOtherDelays (Claims Handling); Denial Of ClaimNoQuestion of Fact; Information Furnished2012-08-02T00:00:002013-01-24T00:00:00Property and CasualtyHomeownersHomeownersCorrespondent Person; Insured2496Ins Co - Licensed/ActiveOrganizationORGDAMAGE DISPUTE; ENGINEER'S REPORT; GR-Claim Evaluation; HAIL; ROOF4015USAA GENERAL INDEMNITY COMPANYThird PartyDelays (Claims Handling)NoCompany Position Upheld; Information Furnished2012-08-02T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1276Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; UNCOOPERATIVE INSURED4016WEBTPA EMPLOYER SERVICES, LLCProviderDelays (Claims Handling)NoNo Jurisdiction; Additional Monies Received2012-08-02T00:00:002012-10-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured17555Third Party AdministratorsOrganizationORG4018AETNA LIFE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-02T00:00:002012-09-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV4020NORTH AMERICAN INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished; Company Position Upheld2012-08-02T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1080Ins Co - Licensed/ActiveOrganizationINDV4021BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderSB418 Rule Violation; Timely Filing Deficiency; Unsatisfactory Settle/OfferYesClean Claims Violation; Stat Pen Pd-Up To 45 Dys Late; Additional Monies Received2012-08-01T00:00:002012-10-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation4022MOLINA HEALTHCARE OF TEXAS, INC.Non-Contracted ProviderDenial Of ClaimNoInformation Furnished; Additional Monies Received; No Jurisdiction2012-08-02T00:00:002012-11-14T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Person; Insured23469Health Maintenance OrgOrganizationORGPRESCRIPTION4023UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDelays (Claims Handling)NoInformation Furnished; No Jurisdiction2012-08-02T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured1348Ins Co - Licensed/ActiveOrganizationINDV4024GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld; Question of Fact2012-08-17T00:00:002012-10-05T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Associated Subject Person2486Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation4025UNITEDHEALTHCARE INSURANCE COMPANYPhysicianUnsatisfactory Settle/OfferYesAdditional Monies Received2012-08-02T00:00:002012-10-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV4027BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDen/N-Pymt MD Nec Trmt N-EmrgNoNo Jurisdiction; Information Furnished2012-08-02T00:00:002012-10-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person; Insured10047Ins Co - Licensed/ActiveOrganizationORG4030SUPERIOR HEALTHPLAN, INC.ProviderDenial Of ClaimNoInformation Furnished2012-08-01T00:00:002012-10-29T00:00:00Children Health Insurance PlanAccident and HealthGroup A&HInsured10198Health Maintenance OrgOrganizationORGGR-Claim Evaluation4031BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoCompany Position Upheld2012-08-12T00:00:002012-09-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company; Insured10047Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation4032UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-08-13T00:00:002012-10-04T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1348Ins Co - Licensed/ActiveOrganizationORG4033AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-02T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORGMULTIPLE INSUREDS4034CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoClaim Settled2012-08-02T00:00:002012-11-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORG4034CIGNA HEALTHCARE OF TEXAS, INC.ProviderUnsatisfactory Settle/OfferNo2012-08-02T00:00:002012-11-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured8294Health Maintenance OrgOrganizationORG4035BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferYesCompany Position Upheld2012-08-02T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4036OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYGR Other Government OfficeUnauthorized ActsNoOther2012-08-16T00:00:002012-09-13T00:00:00Property and CasualtyMiscellaneousNo Line SpecifiedAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDV4036AMEX INSURANCE AGENCYGR Other Government OfficeUnauthorized ActsNoOther2012-08-16T00:00:002012-09-13T00:00:00Property and CasualtyMiscellaneousNo Line SpecifiedAssociated Subject Agency; Insured73708OtherOrganizationINDV4036DANIEL, EZEDINMA EZEKWEGR Other Government OfficeUnauthorized ActsNoOther2012-08-16T00:00:002012-09-13T00:00:00Property and CasualtyMiscellaneousNo Line SpecifiedAssociated Subject Agency; Insured357049Ins Co - Licensed/ActiveIndividualINDV4038AMERICAN INCOME LIFE INSURANCE COMPANYConsumer (Non-Insured)Unauthorized Acts; Unrecorded DocumentsNoInsufficient Information2012-06-22T00:00:002012-09-26T00:00:00Life, Accident and HealthMiscellaneousNo Line Specified109Ins Co - Licensed/ActiveOrganizationINDV4039UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-08-02T00:00:002012-09-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4040UMR, INC.ProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-02T00:00:002012-12-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured23490Self-Funded / ErisaOrganizationORG4042UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-02T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGMULTIPLE INSUREDS4043CONNECTICUT GENERAL LIFE INSURANCE COMPANYPhysicianUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-08-02T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured2851Ins Co - Licensed/ActiveOrganizationINDV4044HUMANA HEALTH PLAN OF TEXAS, INC.ProviderIRO Compnsblty/Extent DecisionNoInformation Furnished; Company Position Upheld2012-08-03T00:00:002012-09-27T00:00:00Utilization Review AgentAccident and HealthGroup A&HCorrespondent Person; Insured702Ins Co - Licensed/ActiveOrganizationORG4045HOMELAND HEALTHCARE, INC.Consumer (Non-Insured)Unauthorized ActsYesReferred To2012-06-28T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Agent; Associated Subject Person38102Third Party AdministratorsOrganizationINDV4045National Better Living AssociationConsumer (Non-Insured)Unauthorized ActsYesReferred To2012-06-28T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Agent; Associated Subject Person66885Unauthorized ActivityOrganizationINDV4046UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDelays (Claims Handling)NoInformation Furnished; Company Position Upheld2012-08-02T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4047METROPOLITAN LIFE INSURANCE COMPANYInsuredPremium and RatingNoPremium Refunded2012-08-02T00:00:002012-12-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&H13191Ins Co - Licensed/ActiveOrganizationORG4048HUMANA INSURANCE COMPANYOtherPrompt Pay; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-02T00:00:002012-11-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company; Insured1040Self-Funded / ErisaOrganizationORG4051MEDCO HEALTH, L.L.C.InsuredDenial Of ClaimNoInformation Furnished2012-08-02T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company54629Third Party AdministratorsOrganizationINDVPRESCRIPTION4053STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-08-03T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDV4054TRAVELERS HOME AND MARINE INSURANCE COMPANY, THERelativeDenial Of Claim; Pre-Existing Condition; Premium and RatingNoNo Jurisdiction; Question of Fact; Company Position Upheld2012-08-06T00:00:002012-11-24T00:00:00Property and CasualtyHomeownersHomeownersInsured3875Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation4058HUMANA INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Not Clean; Information Furnished2012-08-02T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Correspondent Company; Insured1040Ins Co - Licensed/ActiveOrganizationORG4060HUMANA INSURANCE COMPANYInsuredPremium NoticeNoInformation Furnished2012-08-03T00:00:002012-10-03T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1040Ins Co - Licensed/ActiveOrganizationINDV4061MUTUAL OF OMAHA INSURANCE COMPANYInsuredCancellationNoInformation Furnished; Other2012-08-03T00:00:002012-10-12T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Person1977Ins Co - Licensed/ActiveOrganizationINDV4064UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoInsufficient Information2012-08-01T00:00:002012-11-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationORG4065AMERICAN GENERAL LIFE INSURANCE COMPANYInsuredCash ValueNoInformation Furnished2012-08-03T00:00:002012-10-08T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured152Ins Co - Licensed/ActiveOrganizationINDV4067PRAETORIAN INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferYesClaim Settled; Information Furnished2012-08-03T00:00:002012-10-01T00:00:00Property and CasualtyMiscellaneousP & C MiscAssociated Subject Agency687Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE; GR-Claim Evaluation4069UNION SECURITY INSURANCE COMPANYProviderDenial Of ClaimYesAdditional Monies Received2012-08-03T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1215Ins Co - Licensed/ActiveOrganizationORG4069TIME INSURANCE COMPANYProviderDelays (Claims Handling)YesAdditional Monies Received2012-08-03T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1374Ins Co - Licensed/ActiveOrganizationORG4071AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXASNon-Contracted ProviderUnsatisfactory Settle/OfferNoInformation Furnished2012-08-03T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured79Ins Co - Licensed/ActiveOrganizationINDV4072METROPOLITAN LIFE INSURANCE COMPANYRelativeDelays (Claims Handling)NoOther2012-06-16T00:00:002012-11-01T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured13191Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation4073LIBERTY COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and Rating; Refund Of PremiumYesInformation Furnished; Rate Problem Resolved2012-08-03T00:00:002012-10-04T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured3762Ins Co - Licensed/ActiveOrganizationINDV4074CONSOLIDATED LLOYDSInsuredCust Service Claim Handling; Delays (Claims Handling)NoClaim Settled; Information Furnished2012-08-03T00:00:002012-10-01T00:00:00Property and CasualtyHomeownersHomeowners2800Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; TOTAL LOSS4075ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredRefund Of PremiumNoPremium Refunded; Information Furnished2012-08-03T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent936Ins Co - Licensed/ActiveOrganizationINDV4076LIBERTY COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Claim Settled2012-08-03T00:00:002012-10-02T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured3762Ins Co - Licensed/ActiveOrganizationINDVDIMINISHED VALUE; GR-Claim Evaluation4078STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld2012-08-02T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV4079METROPOLITAN LLOYDS INSURANCE COMPANY OF TEXASInsuredDelays (Claims Handling)NoClaim Settled; Information Furnished; Additional Monies Received2012-08-03T00:00:002012-10-02T00:00:00Property and CasualtyAutomobileIndividual Private Pass3848Ins Co - Licensed/ActiveOrganizationINDVTOTAL LOSS4080OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-08-02T00:00:002012-10-02T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; SUPPLEMENTARY PAYMENT; TOTAL LOSS4081AMERITAS LIFE INSURANCE CORP.ProviderDenial Of ClaimYesClaim Settled2012-08-03T00:00:002012-10-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured3034Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation4082FOREMOST INSURANCE COMPANY, GRAND RAPIDS, MICHIGANThird PartyDelays (Claims Handling); Liability DisputeNoInformation Furnished; Company Position Upheld2012-08-03T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2532Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation4083NAUTILUS INSURANCE COMPANYRelativeDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-08-03T00:00:002012-10-01T00:00:00Property and CasualtyHomeownersHomeownersInsured55806Ins Co - Surplus LinesOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF; SENIOR CITIZEN4084VALUEOPTIONS, INC.ProviderClosed-Lack Of Info CmplainantNoRecord Only2012-08-03T00:00:002012-09-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured44252Third Party AdministratorsOrganizationORGMULTIPLE INSUREDS4085MUTUAL OF OMAHA INSURANCE COMPANYRelativeUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-08-03T00:00:002013-01-22T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1977Ins Co - Licensed/ActiveOrganizationINDV4086SELECTCARE OF TEXAS, L.L.C.ProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Additional Payment Expected2012-08-03T00:00:002012-09-10T00:00:00Medicare HMOAccident and HealthIndividual A & HAssociated Subject Person; Insured14275Health Maintenance OrgOrganizationORGSENIOR CITIZEN4087GERMANIA INSURANCE COMPANYInsuredMisleading AdvertisingNoAdditional Monies Received2012-08-02T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass1159Ins Co - Licensed/ActiveOrganizationINDV4087FERTSCH, WILBURN PAULInsuredAgent HandlingNo2012-08-02T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass598439AgentIndividualINDV4088BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderCust Service Claim HandlingNoInformation Furnished; Additional Monies Received2012-08-03T00:00:002012-10-03T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured10047Ins Co - Licensed/ActiveOrganizationORG4089TEXAS FARMERS INSURANCE COMPANYInsuredDenial Of Claim; Unsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished; Company Position Upheld2012-08-03T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF; WATER DAMAGE4090PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Claim Settled; Additional Monies Received2012-08-03T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private PassCorrespondent Person1708Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation4091PACIFIC SPECIALTY INSURANCE COMPANYInsuredDelays (Claims Handling)NoClaim Settled2012-08-02T00:00:002012-09-21T00:00:00Property and CasualtyHomeownersRental10237Ins Co - Licensed/ActiveOrganizationINDV4092AETNA LIFE INSURANCE COMPANYInsuredDelays (Claims Handling)YesClaim Settled2012-08-03T00:00:002012-11-29T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H245Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation4093STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYProviderAssignment of Benefits; Delays (Claims Handling)NoInformation Furnished; Company Position Upheld2012-08-03T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDVCHIROPRACTIC4094OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYRelativeDelays (Policyholder Service); Refund Of PremiumNoPremium Refunded; Information Furnished2012-08-02T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Associated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDV4095TRAVELERS LLOYDS INSURANCE COMPANY, THEThird PartyDelays (Claims Handling)NoClaim Settled; Information Furnished2012-08-02T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured Company777Ins Co - Licensed/ActiveOrganizationINDV4096NEW HAMPSHIRE INSURANCE COMPANYInsuredDWC Other; Denial Of Claim; Medical NecessityNoInformation Furnished2012-07-10T00:00:002012-10-22T00:00:00Workers' CompensationAccident and HealthGroup A&HThird Party Admin-Licensed1883Ins Co - Licensed/ActiveOrganizationINDV4097TEXAS MUTUAL INSURANCE COMPANYPhysicianDenial Of ClaimYesInformation Furnished; Additional Monies Received2012-07-24T00:00:002012-09-27T00:00:00Workers Compensation NetworkAccident and HealthGroup A&HInsured3500Ins Co - Licensed/ActiveOrganizationINDV4098FARMERS INSURANCE EXCHANGEInsuredUnsatisfactory Settle/OfferYesAdditional Monies Received; Information Furnished2012-08-02T00:00:002012-10-09T00:00:00Property and CasualtyHomeownersHomeowners2668Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF4099DELTA DENTAL OF CALIFORNIAProviderDenial Of ClaimNoCompany Position Upheld; Information Furnished2012-08-16T00:00:002012-09-26T00:00:00Children Health Insurance PlanAccident and HealthGroup A&HCorrespondent Person; Insured44231Ins Co - Licensed/ActiveOrganizationORG4100BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoContract Language/Legal Issue2012-08-16T00:00:002012-11-08T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV4101CHRYSLER GROUP LLCInsuredDenial Of ClaimNoReferred To2012-08-03T00:00:002012-10-31T00:00:00Property and CasualtyMiscellaneousWarranty Contract75996OtherOrganizationINDVDEDUCTIBLE4103UNITEDHEALTHCARE INSURANCE COMPANYContracted ProviderDelays (Claims Handling)YesInformation Furnished; Claim Not Clean2012-08-06T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4104ALLSTATE COUNTY MUTUAL INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)No2012-08-03T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured2228Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING4104WARMSLEY, KEISHA ALFORDThird PartyCust Service Claim HandlingNoCorrective Action Taken2012-08-03T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured296818Claims AdjusterIndividualINDVADJUSTER'S HANDLING4104THOMAS, COREY LEEThird PartyCust Service Claim Handling; Delays (Claims Handling)NoInformation Furnished2012-08-03T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured652503Claims AdjusterIndividualINDVADJUSTER'S HANDLING4105UNITEDHEALTHCARE INSURANCE COMPANYInsuredDelays (Policyholder Service)NoNo Jurisdiction2012-08-06T00:00:002012-09-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV4106STARR INDEMNITY & LIABILITY COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-08-02T00:00:002012-10-01T00:00:00Property and CasualtyMiscellaneousInland MarineAssociated Subject Agency; Insured Company997Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation; REPAIR CHOICE4107UNITED SERVICES AUTOMOBILE ASSOCIATIONInsuredDelays (Claims Handling)NoClaim Settled; Information Furnished2012-08-03T00:00:002012-10-01T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1254Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; LOSS OF USE; TOTAL LOSS4107GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-08-03T00:00:002012-10-01T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2486Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; LOSS OF USE; TOTAL LOSS4108ASSURITY LIFE INSURANCE COMPANYInsuredAgent HandlingYesInformation Furnished2012-08-06T00:00:002012-10-04T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2533Ins Co - Licensed/ActiveOrganizationINDV4108NIX, SHARON KAYInsuredAgent HandlingNoInformation Furnished2012-08-06T00:00:002012-10-04T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H375632AgentIndividualINDV4109HUMANA INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoAdditional Monies Received; Information Furnished2012-08-03T00:00:002012-10-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORG4110GROUP & PENSION ADMINISTRATORS, INC.ProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-06T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured32390Self-Funded / ErisaOrganizationINDVGR-Claim Evaluation4111SHERMAN, CLAUDE ANTHONYInsurance CompanyMisrepresentationYesInformation Furnished2012-08-20T00:00:002012-09-17T00:00:00Property and CasualtyHomeownersHomeownersAlias Name; Correspondent Person; Insured699596Public Insurance AdjusterIndividualORG4112BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONRelativePremium NoticeYesInformation Furnished; Policy Issued/Restored2012-08-06T00:00:002012-10-02T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured10047Ins Co - Licensed/ActiveOrganizationINDV4115MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANYInsuredDelays (Policyholder Service)NoContract Language/Legal Issue; Information Furnished2012-08-16T00:00:002012-09-20T00:00:00Life, Accident and HealthLife & AnnuityIRA 2115Ins Co - Licensed/ActiveOrganizationINDV4116TRANSAMERICA LIFE INSURANCE COMPANYProviderDelays (Claims Handling)YesClaim Settled2012-08-06T00:00:002012-11-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1983Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation4117ACCC INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished2012-08-02T00:00:002012-11-08T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED4118PRUDENTIAL ANNUITIES LIFE ASSURANCE CORPORATIONConsumer (Non-Insured)MisrepresentationYesClaim Settled2012-08-03T00:00:002012-10-24T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesInsured; Insured Company2388Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN4119OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYRelativeDelays (Claims Handling)NoCompany Position Upheld2012-08-02T00:00:002012-09-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDV4120GERMANIA INSURANCE COMPANYRelativeDelays (Claims Handling)NoCompany Position Upheld2012-08-02T00:00:002012-09-20T00:00:00Property and CasualtyAutomobileIndividual Private PassDeceased Person1159Ins Co - Licensed/ActiveOrganizationINDV4121Moore County Hospital DistrictConsumer (Non-Insured)Not Within TDI JurisdictionNoRecord Only; No Jurisdiction2012-08-03T00:00:002012-08-28T00:00:00Life, Accident and HealthMiscellaneousNo Line Specified68159Hospital / Doctor / DentistOrganizationINDV4122AETNA HEALTH INC.ProviderDelays (Claims Handling); Prompt PayYesClaim Not Clean2012-08-03T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured3522Ins Co - Licensed/ActiveOrganizationORG4123UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-03T00:00:002012-09-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV4125NATIONAL PACIFIC DENTAL, INC.ProviderDenial Of ClaimYesClaim Settled2012-08-03T00:00:002012-10-18T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured3669Health Maintenance OrgOrganizationORGGR-Claim Evaluation4126HUMANA INSURANCE COMPANYInsuredDenial Of Claim; Medical NecessityNoContract Language/Legal Issue; Information Furnished2012-08-06T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationINDV4128UNITED TEACHER ASSOCIATES INSURANCE COMPANYInsuredRefund Of PremiumNoInformation Furnished2012-08-06T00:00:002012-10-09T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H3486Ins Co - Licensed/ActiveOrganizationINDV4131BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoInsufficient Information2012-08-06T00:00:002012-11-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDVPRESCRIPTION4133METROPOLITAN LIFE INSURANCE COMPANYRelativeUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-08-06T00:00:002012-09-21T00:00:00Life, Accident and HealthLife & AnnuityGroup LifeAssociated Subject Company; Deceased Person13191Ins Co - Licensed/ActiveOrganizationINDV4136BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredRefusal to InsureYesInformation Furnished2012-08-06T00:00:002012-10-04T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationINDV4138UNITEDHEALTHCARE INSURANCE COMPANYProviderOtherNoInformation Furnished2012-08-06T00:00:002012-10-05T00:00:00Life, Accident and HealthMiscellaneousNo Line Specified1348Ins Co - Licensed/ActiveOrganizationINDV4140CONSUMERS COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished; Company Position Upheld2012-08-03T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private Pass2806Ins Co - Licensed/ActiveOrganizationINDV4141STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeNoInformation Furnished; Question of Fact2012-08-03T00:00:002012-11-02T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation4143UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDenial Of ClaimYesInformation Furnished2012-08-07T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV4144AMERICAN FAMILY LIFE ASSURANCE COMPANY OF COLUMBUSAgentCommissionsNoNo Jurisdiction2012-08-06T00:00:002012-09-21T00:00:00Life, Accident and HealthMiscellaneousNo Line Specified2655Ins Co - Licensed/ActiveOrganizationINDV4145UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-08-07T00:00:002012-09-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV4147AMERICAN GENERAL LIFE AND ACCIDENT INSURANCE COMPANYInsuredCash ValueNoCompany Position Upheld2012-08-06T00:00:002012-10-18T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1967Ins Co - Licensed/ActiveOrganizationINDV4148CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction; Additional Monies Received2012-08-07T00:00:002012-09-06T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured25422Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN4149UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDenial Of ClaimNoNo Jurisdiction2012-08-07T00:00:002012-09-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV4150UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDenial Of ClaimNoNo Jurisdiction2012-08-07T00:00:002012-09-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV4151AETNA LIFE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferYesAdditional Monies Received2012-08-06T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person245Ins Co - Licensed/ActiveOrganizationINDV4153UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDenial Of ClaimYesInformation Furnished2012-08-07T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV4156UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-08-06T00:00:002012-08-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN4157ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoCompany Position Upheld; Additional Monies Received; Information Furnished2012-08-02T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDVTOTAL LOSS4158BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredOtherNoNo Jurisdiction2012-08-06T00:00:002012-11-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Agency10047Self-Funded / ErisaOrganizationINDV4161SHA, L.L.C.InsuredUnsatisfactory Settle/OfferYesAdditional Monies Received2012-08-07T00:00:002012-10-13T00:00:00Health Maintenance OrgAccident and HealthGroup A&H7717Health Maintenance OrgOrganizationINDV4162BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-08-06T00:00:002012-12-07T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationINDV4163METROPOLITAN LIFE INSURANCE COMPANYInsuredPremium NoticeYesAdditional Monies Received2012-08-07T00:00:002012-10-11T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life13191Ins Co - Licensed/ActiveOrganizationINDV4164HUMANA INSURANCE COMPANYPhysicianDenial Of ClaimNoNo Jurisdiction2012-08-20T00:00:002012-09-05T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1040Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN4165AMERICAN NATIONAL INSURANCE COMPANYRelativeOtherNoInformation Furnished2012-08-06T00:00:002012-10-05T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured135Ins Co - Licensed/ActiveOrganizationINDV4166STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYAttorneyDelays (Claims Handling)NoAdditional Payment Expected2012-08-02T00:00:002012-09-21T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured1510Ins Co - Licensed/ActiveOrganizationINDV4167HUMANA INSURANCE COMPANYPhysicianDenial Of ClaimNoNo Jurisdiction2012-08-20T00:00:002012-09-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN4169MUTUAL ASSURANCE ADMINISTRATORS, INC.InsuredDenial Of ClaimNoNo Jurisdiction2012-08-07T00:00:002012-11-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&H47400Self-Funded / ErisaOrganizationINDV4170AETNA LIFE INSURANCE COMPANYInsuredDelays (Claims Handling)NoNo Jurisdiction2012-08-07T00:00:002012-10-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV4173HUMANA INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferYesAdditional Monies Received2012-08-06T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationINDV4175BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONPhysicianDelays (Policyholder Service)NoInformation Furnished2012-08-07T00:00:002012-10-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV4181UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-07T00:00:002012-09-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV4183WASHINGTON NATIONAL INSURANCE COMPANYInsuredDelays (Policyholder Service)NoInformation Furnished2012-07-25T00:00:002012-10-10T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesAssociated Subject Company1196Ins Co - Licensed/ActiveOrganizationINDV4183PHILADELPHIA AMERICAN LIFE INSURANCE COMPANYInsuredDelays (Policyholder Service)NoInformation Furnished2012-07-25T00:00:002012-10-10T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesAssociated Subject Company1777Ins Co - Licensed/ActiveOrganizationINDV4183MONUMENTAL LIFE INSURANCE COMPANYInsuredDelays (Policyholder Service)NoInformation Furnished2012-07-25T00:00:002012-10-10T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesAssociated Subject Company2010Ins Co - Licensed/ActiveOrganizationINDV4184UNITED TEACHER ASSOCIATES INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished2012-08-06T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H3486Ins Co - Licensed/ActiveOrganizationINDV4186PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYConsumer (Non-Insured)Cust Service Claim Handling; Delays (Claims Handling)YesInformation Furnished; Additional Monies Received2012-08-03T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation4187CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-06T00:00:002012-10-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORG4188BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-06T00:00:002012-09-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4189BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-08-06T00:00:002012-09-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4190CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-08-06T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Self-Funded / ErisaOrganizationORG4192CONSECO LIFE INSURANCE COMPANYInsuredPremium NoticeNoInformation Furnished; Contract Language/Legal Issue2012-08-06T00:00:002012-10-29T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2113Ins Co - Licensed/ActiveOrganizationINDV4193CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-06T00:00:002012-09-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured2851Ins Co - Licensed/ActiveOrganizationORG4194HUMANA INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-06T00:00:002012-11-07T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured Company1040Ins Co - Licensed/ActiveOrganizationORG4196WASHINGTON NATIONAL INSURANCE COMPANYAgentDelays (Policyholder Service)NoInformation Furnished; Contract Language/Legal Issue2012-08-06T00:00:002012-10-11T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company; Deceased Person1196Ins Co - Licensed/ActiveOrganizationINDV4198CONTINENTAL LIFE INSURANCE COMPANY OF BRENTWOOD, TENNESSEEInsuredMisrepresentationNoInformation Furnished2012-08-06T00:00:002012-11-07T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company3707Ins Co - Licensed/ActiveOrganizationINDV4198AMERICAN SENIOR BENEFITS, LLCInsuredMisrepresentationNoInformation Furnished2012-08-06T00:00:002012-11-07T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company15853Insurance AgencyOrganizationINDV4198MAIALE, DIANE RANAEInsuredMisrepresentationNoInformation Furnished2012-08-06T00:00:002012-11-07T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company854501AgentIndividualINDV4199BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONPhysicianDelays (Claims Handling)NoNo Jurisdiction2012-08-21T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4200NATIONWIDE MUTUAL FIRE INSURANCE COMPANYInsuredOtherNoInformation Furnished2012-07-19T00:00:002012-09-18T00:00:00Property and CasualtyMiscellaneousP & C Misc1936Ins Co - Licensed/ActiveOrganizationINDVMULTIPLE INSUREDS4200HARBOR, HAL LInsuredOtherNo2012-07-19T00:00:002012-09-18T00:00:00Property and CasualtyMiscellaneousP & C Misc113731AgentIndividualINDVMULTIPLE INSUREDS4201UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.ProviderDelays (Claims Handling)NoNo Jurisdiction; Information Furnished2012-08-06T00:00:002012-09-21T00:00:00Medicare HMOAccident and HealthGroup A&HCorrespondent Person; Insured; Third Party Admin-Non Licensed3425Health Maintenance OrgOrganizationORGSENIOR CITIZEN4202BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-06T00:00:002012-10-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4204BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoNo Jurisdiction; Information Furnished2012-08-06T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured10047Ins Co - Licensed/ActiveOrganizationORG4205LIBERTY COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished; Company Position Upheld2012-08-03T00:00:002012-10-01T00:00:00Property and CasualtyAutomobileIndividual Private Pass3762Ins Co - Licensed/ActiveOrganizationINDV4206GREAT SOUTHERN LIFE INSURANCE COMPANYBeneficiaryCash ValueNoInformation Furnished; Additional Monies Received2012-08-06T00:00:002012-10-30T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person1046Ins Co - Licensed/ActiveOrganizationINDV4208BNSF RAILWAY COMPANYAttorneyUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-03T00:00:002013-01-31T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person68157Self-Funded / ErisaOrganizationORG4209UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoInformation Furnished; No Jurisdiction2012-08-06T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4211BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling); Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-06T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4212UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of Claim; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-06T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4213USAA GENERAL INDEMNITY COMPANYThird PartyDelays (Claims Handling)NoAdditional Payment Expected; Information Furnished; Additional Monies Received2012-08-03T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1276Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED4215AETNA LIFE INSURANCE COMPANYContracted ProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-08-06T00:00:002012-11-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person; Insured245Self-Funded / ErisaOrganizationORG4216REPUBLIC LLOYDSConsumer (Non-Insured)Cust Service Claim Handling; Denial Of ClaimNoCompany Position Upheld; Information Furnished2012-08-03T00:00:002012-09-26T00:00:00Property and CasualtyHomeownersHomeowners2299Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; HAIL; OVERHEAD AND PROFIT; ROOF4217BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferYesClaim Settled; Additional Monies Received; Other2012-08-06T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4218BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of Claim; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-06T00:00:002012-09-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4219STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXASThird PartyDenial Of Claim; Liability DisputeNoCompany Position Upheld2012-08-03T00:00:002012-12-11T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1506Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation4220STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished2012-08-03T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING4221AMERICAN GENERAL LIFE INSURANCE COMPANYInsuredDelays (Policyholder Service)NoInformation Furnished2012-08-06T00:00:002012-10-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person152Ins Co - Licensed/ActiveOrganizationINDV4222UNITED OF OMAHA LIFE INSURANCE COMPANYInsuredPremium NoticeNoContract Language/Legal Issue; Information Furnished2012-08-06T00:00:002012-10-18T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1281Ins Co - Licensed/ActiveOrganizationINDV4223PRINCIPAL LIFE INSURANCE COMPANYProviderDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-08-06T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured3032Ins Co - Licensed/ActiveOrganizationORG4225FOREMOST COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoClaim Settled; Additional Monies Received; Information Furnished2012-08-06T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2530Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF; UNCOOPERATIVE INSURED4226HARTFORD LIFE AND ACCIDENT INSURANCE COMPANYInsuredCust Service Claim HandlingNoInformation Furnished; Contract Language/Legal Issue2012-08-07T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2383Ins Co - Licensed/ActiveOrganizationINDV4227LOYA INSURANCE COMPANYAttorneyDelays (Claims Handling)NoCompany Position Upheld2012-08-06T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person15643Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING4227CHAPMAN, JINA LEAAttorneyCust Service Claim HandlingNoInformation Furnished2012-08-06T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person713292Claims AdjusterIndividualINDVADJUSTER'S HANDLING4228ACCC INSURANCE COMPANYInsuredCancellation; Refund Of PremiumYesCorrective Action Taken; Additional Monies Received; Information Furnished2012-08-06T00:00:002012-10-04T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency9825Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA4229LIBERTY MUTUAL FIRE INSURANCE COMPANYInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferNoAdditional Payment Expected2012-08-06T00:00:002012-11-21T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent2209Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; WATER DAMAGE4230FARMERS INSURANCE EXCHANGEOtherAgent HandlingNoInformation Furnished2012-08-06T00:00:002012-11-26T00:00:00Property and CasualtyMiscellaneousP & C Misc2668Ins Co - Licensed/ActiveOrganizationINDV4230CANTU, BARBARA GALEOtherAgent HandlingYesInsufficient Information2012-08-06T00:00:002012-11-26T00:00:00Property and CasualtyMiscellaneousP & C Misc640553AgentIndividualINDV4231FARMERS INSURANCE EXCHANGELienholderAssignment of Benefits; Recoupment Of Claims PaymentNoContract Language/Legal Issue2012-08-06T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileBusiness AutomobileInsured2668Ins Co - Licensed/ActiveOrganizationINDV4232ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling)NoContract Language/Legal Issue; Question of Fact; Information Furnished2012-08-03T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured936Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING4233UNITRIN COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received; Claim Settled; Information Furnished2012-08-06T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1856Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; UNCOOPERATIVE INSURED4234DAIRYLAND COUNTY MUTUAL INSURANCE COMPANY OF TEXASInsuredDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-08-06T00:00:002012-10-10T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency2737Ins Co - Licensed/ActiveOrganizationINDV4234GERMANIA GENERAL AGENCY INCInsuredAgent HandlingNoQuestion of Fact2012-08-06T00:00:002012-10-10T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency5521Insurance AgencyOrganizationINDV4235ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICAInsuredDelays (Policyholder Service)NoInformation Furnished; Contract Language/Legal Issue2012-08-21T00:00:002012-11-27T00:00:00Life, Accident and HealthLife & AnnuityIRA 910Ins Co - Licensed/ActiveOrganizationINDV4235RANDOLPH, WAYMAN CHARLESInsuredAgent Handling; MisrepresentationYesQuestion of Fact2012-08-21T00:00:002012-11-27T00:00:00Life, Accident and HealthLife & AnnuityIRA 422771AgentIndividualINDV4236GEOVERA SPECIALTY INSURANCE COMPANYInsuredRefund Of PremiumNoContract Language/Legal Issue; Information Furnished2012-08-06T00:00:002012-11-20T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company56985Ins Co - Surplus LinesOrganizationINDV4236PHILLIPS, RICHARD EInsuredAgent HandlingNoInformation Furnished2012-08-06T00:00:002012-11-20T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company687025AgentIndividualINDV4237BALBOA INSURANCE COMPANYInsuredRefund Of PremiumNoInformation Furnished; Company Position Upheld2012-08-06T00:00:002012-10-11T00:00:00Property and CasualtyHomeownersHomeowners3083Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA4238FOREMOST LLOYDS OF TEXASInsuredDelays (Policyholder Service); Refund Of PremiumYesAdditional Monies Received; Information Furnished2012-08-06T00:00:002012-10-01T00:00:00Property and CasualtyHomeownersHomeowners698Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNDERWRITING CRITERIA4239COLONIAL COUNTY MUTUAL INSURANCE COMPANYRelativeDelays (Claims Handling)NoClaim Settled; Additional Monies Received; Information Furnished2012-08-06T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private Pass2455Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; UNCOOPERATIVE INSURED4240TEXAS FARMERS INSURANCE COMPANYInsuredDenial Of ClaimNoQuestion of Fact; Contract Language/Legal Issue; Information Furnished2012-08-06T00:00:002012-10-01T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDVAPPRAISAL; BURDEN OF PROOF; COVERAGE DISPUTE; DAMAGE DISPUTE; HAIL; ROOF; UNDERWRITING CRITERIA4241HUMANA INSURANCE COMPANYProviderDelays (Claims Handling)NoInsufficient Information2012-08-07T00:00:002012-11-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationINDV4242BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction2012-08-06T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4243JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.)InsuredMisrepresentationNoInformation Furnished2012-08-06T00:00:002012-10-10T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1148Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN4243MUIRHEAD, BENJAMIN MICHAELInsuredMisrepresentationNoInformation Furnished2012-08-06T00:00:002012-10-10T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life223043AgentIndividualINDVSENIOR CITIZEN4244LIBERTY COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-03-29T00:00:002012-09-07T00:00:00Property and CasualtyAutomobileIndividual Private Pass3762Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation4245DELTA DENTAL INSURANCE COMPANYRelativeDenial Of ClaimYesClaim Settled2012-08-06T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured2752Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation4246OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)NoInformation Furnished; Question of Fact2012-08-04T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Associated Subject Company1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING4247TEXAS FAIR PLAN ASSOCIATIONInsuredUnsatisfactory Settle/OfferNoAppraisal Process Invoked; Complainant Retained Attorney; Additional Monies Received2012-08-02T00:00:002012-11-01T00:00:00Property and CasualtyHomeownersHomeownersGR Elected Official18208Ins Co - Licensed/ActiveOrganizationINDVHAIL; ROOF; WATER DAMAGE4247MORALES, PEDRO ALCANTARInsuredAgent HandlingYesInformation Furnished2012-08-02T00:00:002012-11-01T00:00:00Property and CasualtyHomeownersHomeownersGR Elected Official40753AgentIndividualINDVHAIL; ROOF; WATER DAMAGE4248UNITEDHEALTHCARE INSURANCE COMPANYRelativeDelays In AuthorizationNoQuestion of Fact; Contract Language/Legal Issue2012-08-21T00:00:002012-09-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HGR Elected Official; Insured1348Ins Co - Licensed/ActiveOrganizationINDVACQUIRED BRAIN INJURY4249ALLSTATE INSURANCE COMPANYInsuredCancellation; Denial Of ClaimNoClaim Settled; Information Furnished; Additional Monies Received2012-08-06T00:00:002012-10-02T00:00:00Property and CasualtyHomeownersRental168Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNDERWRITING CRITERIA4250FOREMOST LLOYDS OF TEXASInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferNoContract Language/Legal Issue; Question of Fact; Information Furnished2012-08-06T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeowners698Ins Co - Licensed/ActiveOrganizationINDVACV; DEPRECIATION; GR-Claim Evaluation; OVERHEAD AND PROFIT; ROOF4251DELTA DENTAL OF CALIFORNIARelativeDenial Of ClaimNoInformation Furnished2012-08-06T00:00:002012-09-19T00:00:00Children Health Insurance PlanAccident and HealthGroup A&HCorrespondent Person; Insured71773Ins Co - Licensed/ActiveOrganizationINDV4252OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Liability DisputeNoCompany Position Upheld; Information Furnished; Additional Monies Received2012-08-06T00:00:002012-12-27T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Person; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; DIMINISHED VALUE; GR-Claim Evaluation4253CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-08-06T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured2851Self-Funded / ErisaOrganizationORGGR-Claim Evaluation4254ASI LLOYDSInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoClaim Settled; Information Furnished; Additional Monies Received2012-08-06T00:00:002012-10-10T00:00:00Property and CasualtyHomeownersHomeowners14728Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF; DAMAGE DISPUTE; HAIL; ROOF4255AMERITAS LIFE INSURANCE CORP.ProviderDelays (Claims Handling)NoContract Language/Legal Issue2012-08-06T00:00:002012-10-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured3034Ins Co - Licensed/ActiveOrganizationORG4256OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Payment Expected; Information Furnished; Additional Monies Received2012-08-06T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF; UNCOOPERATIVE INSURED4257REGAL LIFE OF AMERICA INSURANCE COMPANYInsuredRefund Of PremiumYesAdditional Monies Received2012-08-06T00:00:002012-10-26T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1702Ins Co - Licensed/ActiveOrganizationINDV4259UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.ProviderDenial Of Claim; Unsatisfactory Settle/OfferYesAdditional Monies Received2012-08-06T00:00:002012-11-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured3425Health Maintenance OrgOrganizationORG4260PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld; Information Furnished2012-08-06T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1708Ins Co - Licensed/ActiveOrganizationINDVPOLICY EXCLUSION; UNDERWRITING CRITERIA4261BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-08-06T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4262ACCC INSURANCE COMPANYConsumer (Non-Insured)Cust Service Claim Handling; Unsatisfactory Settle/OfferNoClaim Settled; Information Furnished2012-08-06T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured9825Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; REPLACEMENT VEHICLE4263HUMANA INSURANCE COMPANYProviderDenial Of ClaimYesAdditional Monies Received; Information Furnished2012-08-06T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person; Insured1040Ins Co - Licensed/ActiveOrganizationORG4264GARRISON PROPERTY AND CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received; Claim Settled2012-08-06T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private Pass1697Ins Co - Licensed/ActiveOrganizationINDV4265PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredCust Service Claim Handling; Denial Of ClaimYesCorrective Action Taken; Additional Payment Expected2012-08-06T00:00:002012-10-05T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation4266BRISTOL WEST SPECIALTY INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished; Contract Language/Legal Issue2012-08-06T00:00:002012-10-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass8129Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF4267BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-08-06T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORGGRANDFATHERED HEALTH PLAN4269TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYInsuredCancellationNoCompany Position Upheld; Information Furnished2012-08-06T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private Pass1450Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNDERWRITING CRITERIA4270UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)YesClean Claims Violation; Stat Pen Pd-Over 90 Dys Late2012-08-06T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured1348Ins Co - Licensed/ActiveOrganizationORG4271ALLSTATE INDEMNITY COMPANYInsuredCancellation; Endorsement / RiderNoInformation Furnished2012-08-06T00:00:002012-10-29T00:00:00Property and CasualtyHomeownersHomeowners167Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE; HAIL; ROOF4271RICE, ANDREW CLIFTONInsuredAgent HandlingNoQuestion of Fact2012-08-06T00:00:002012-10-29T00:00:00Property and CasualtyHomeownersHomeowners555779AgentIndividualINDVDEDUCTIBLE; HAIL; ROOF4272HOME STATE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Company Position Upheld; Additional Payment Expected2012-08-06T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency2362Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF; UNCOOPERATIVE INSURED4273STATE FARM LLOYDSInsuredDelays (Claims Handling)NoContract Language/Legal Issue; Question of Fact2012-08-04T00:00:002012-10-15T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVSUBROGATION4274AMERICAN ACCESS CASUALTY COMPANYRelativeDelays (Claims Handling)NoInformation Furnished2012-08-06T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person30332Ins Co - Licensed/ActiveOrganizationINDV4275AMERICAN GENERAL LIFE INSURANCE COMPANYInsuredDelays (Policyholder Service)NoInformation Furnished2012-08-06T00:00:002012-10-29T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities152Ins Co - Licensed/ActiveOrganizationINDV4277COLONIAL LLOYDSInsuredCancellationNoContract Language/Legal Issue; Information Furnished2012-08-06T00:00:002012-09-24T00:00:00Property and CasualtyHomeownersHomeowners768Ins Co - Licensed/ActiveOrganizationINDV4278STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredLiability DisputeNoQuestion of Fact; Information Furnished; Contract Language/Legal Issue2012-08-06T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF; UNDERWRITING CRITERIA4279STATE FARM LLOYDSInsuredDelays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-08-06T00:00:002012-10-16T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; HAIL; ROOF4280BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-08-06T00:00:002012-11-20T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationINDV4281HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.ProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-06T00:00:002012-09-10T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Person; Insured27417Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN4282AAA TEXAS COUNTY MUTUAL INSURANCE COMPANYAgentNot Within TDI JurisdictionNoNo Jurisdiction; Information Furnished2012-08-06T00:00:002012-11-13T00:00:00Property and CasualtyMiscellaneousNo Line Specified2286Ins Co - Licensed/ActiveOrganizationINDV4283UNITEDHEALTHCARE INSURANCE COMPANYInsuredCancellationNoNo Jurisdiction2012-08-06T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company1348Ins Co - Licensed/ActiveOrganizationINDV4284Texas Department of Insurance (Consumer Protection)Third PartyNot Within TDI Jurisdiction; OtherNoOther2012-08-06T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured75246OtherOrganizationINDV4285DRIVER'S INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished2012-08-06T00:00:002012-09-27T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person2038Ins Co - Licensed/ActiveOrganizationINDV4286LIBERTY COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished2012-08-06T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass3762Ins Co - Licensed/ActiveOrganizationINDVCOMPARATIVE NEGLIGENCE; DAMAGE DISPUTE4287DELTA DENTAL OF CALIFORNIAProviderDelays (Claims Handling)NoInformation Furnished; No Jurisdiction2012-07-30T00:00:002012-09-28T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Person; Insured44231OtherOrganizationINDV4288ALLSTATE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoCompany Position Upheld; Information Furnished2012-08-06T00:00:002012-10-01T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2228Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE4289UNITEDHEALTHCARE INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-07-30T00:00:002012-09-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV4290ARISA INTERNATIONALThird PartyCust Service Claim HandlingNoNo Jurisdiction2012-08-06T00:00:002012-12-06T00:00:00Property and CasualtyAutomobileIndividual Private Pass66466AgentOrganizationINDV4291SENTRY SELECT INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoComplainant Retained Attorney2012-08-06T00:00:002012-11-21T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured Company1555Ins Co - Licensed/ActiveOrganizationINDVCOMPARATIVE NEGLIGENCE; GR-Claim Evaluation; SUBROGATION; TOTAL LOSS4292REGAL LIFE OF AMERICA INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue2012-08-06T00:00:002013-01-23T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1702Ins Co - Licensed/ActiveOrganizationINDV4293UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-07-30T00:00:002012-09-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV4294ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYRelativeCust Service Claim Handling; Unsatisfactory Settle/OfferYesClaim Settled2012-08-06T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDV4295ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYConsumer (Non-Insured)Endorsement / RiderYesCorrective Action Taken; Information Furnished2012-08-06T00:00:002012-09-24T00:00:00Property and CasualtyAutomobileIndividual Private PassCorrespondent Company936Ins Co - Licensed/ActiveOrganizationINDV4296DELTA DENTAL INSURANCE COMPANYProviderDelays (Claims Handling)NoInformation Furnished; Contract Language/Legal Issue2012-07-30T00:00:002012-11-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured2752Ins Co - Licensed/ActiveOrganizationINDV4297DIRECT GENERAL INSURANCE COMPANYAttorneyCust Service Claim Handling; Delays (Claims Handling)YesInformation Furnished; Additional Monies Received2012-08-06T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass20747Ins Co - Licensed/ActiveOrganizationORGAFTERMARKET PARTS; COVERAGE DISPUTE; GR-Claim Evaluation; LOSS OF USE4298BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of Claim; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-07-30T00:00:002012-09-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV4301DELTA DENTAL INSURANCE COMPANYProviderDelays (Claims Handling)NoContract Language/Legal Issue2012-07-30T00:00:002013-02-05T00:00:00Children Health Insurance PlanAccident and HealthGroup A&HInsured2752Ins Co - Licensed/ActiveOrganizationINDV4306ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling)YesAdditional Monies Received; Information Furnished2012-08-06T00:00:002012-09-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company9825Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING4307FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoCompany Position Upheld2012-08-07T00:00:002012-10-01T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDV430821ST CENTURY CENTENNIAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-08-06T00:00:002012-09-26T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured771Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING4310UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoInsufficient Information2012-08-07T00:00:002012-11-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationORG4311OHIO CASUALTY INSURANCE COMPANY, THEInsuredCancellationNoCompany Position Upheld; Contract Language/Legal Issue; Information Furnished2012-08-06T00:00:002012-11-29T00:00:00Property and CasualtyAutomobileBusiness AutomobileAssociated Subject Person1874Ins Co - Licensed/ActiveOrganizationORG4312UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.ProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-07T00:00:002012-10-13T00:00:00Medicare HMOAccident and HealthIndividual A & HInsured14666Health Maintenance OrgOrganizationINDVSENIOR CITIZEN4313ACCC INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoClaim Settled2012-08-06T00:00:002012-09-24T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured9825Ins Co - Licensed/ActiveOrganizationINDVTOTAL LOSS4315JOHN ALDEN LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-07-30T00:00:002012-10-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2495Ins Co - Licensed/ActiveOrganizationORG4316CHICAGO TITLE INSURANCE COMPANYConsumer (Non-Insured)ConversionYesReferred for Disciplinary Actn2012-08-06T00:00:002013-01-09T00:00:00Property and CasualtyMiscellaneousTitle InsuranceAssociated Agent; Associated Subject Company51988Ins Co - Licensed/ActiveOrganizationINDV4317BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of Claim; Medical NecessityNoNo Jurisdiction2012-08-07T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4318OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYConsumer (Non-Insured)Delays (Claims Handling); Liability DisputeNoContract Language/Legal Issue2012-08-06T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDV4318PRONTO GENERAL AGENCY LTDConsumer (Non-Insured)Delays (Claims Handling); Liability DisputeNo2012-08-06T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency75673AgentOrganizationINDV4320LIBERTY COUNTY MUTUAL INSURANCE COMPANYThird PartyCust Service Claim Handling; Unsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received2012-08-06T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured3762Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; DIMINISHED VALUE4321SOUTHERN COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Payment Expected; Information Furnished2012-08-06T00:00:002012-09-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass1583Ins Co - Licensed/ActiveOrganizationINDV4322AMERICAN NATIONAL INSURANCE COMPANYRelativeCash ValueNoInformation Furnished2012-08-07T00:00:002012-10-26T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured135Ins Co - Licensed/ActiveOrganizationINDV4323CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-08-07T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORG4324GERMANIA FARM MUTUAL INSURANCE ASSOCIATIONInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received; Information Furnished2012-08-06T00:00:002012-10-17T00:00:00Property and CasualtyHomeownersHomeowners2468Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE4325HARTFORD LLOYD'S INSURANCE COMPANYThird PartyDelays (Claims Handling)YesInformation Furnished; Additional Monies Received2012-08-06T00:00:002012-09-26T00:00:00Property and CasualtyLiabilityGeneral Liability1017Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; DAMAGE DISPUTE; GR-Claim Evaluation4326UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoInformation Furnished; No Jurisdiction2012-08-07T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV4327BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoNo Jurisdiction2012-08-07T00:00:002012-09-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV4329HUMANA INSURANCE COMPANYGR Other Government OfficeMisrepresentationNoInformation Furnished2012-08-22T00:00:002012-10-13T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1040Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN4329HENDRICKS, GRADY ALLENGR Other Government OfficeMisrepresentationYes2012-08-22T00:00:002012-10-13T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured607432AgentIndividualORGSENIOR CITIZEN4331PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Payment Expected; Question of Fact2012-08-22T00:00:002012-09-18T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1708Ins Co - Licensed/ActiveOrganizationINDV4332UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.GR Other Government OfficeMisrepresentationNoInformation Furnished2012-08-22T00:00:002012-09-24T00:00:00Medicare HMOAccident and HealthIndividual A & HInsured3425Health Maintenance OrgOrganizationORG4332PILCHER, FRANK HUGHGR Other Government OfficeMisrepresentationNoInformation Furnished2012-08-22T00:00:002012-09-24T00:00:00Medicare HMOAccident and HealthIndividual A & HInsured795930AgentIndividualORG4333CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANYGR Other Government OfficeMisrepresentationNoInformation Furnished2012-08-22T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured25422Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN4333FLORES, ALEJANDRO MANUELGR Other Government OfficeMisrepresentationNoInformation Furnished2012-08-22T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured447183AgentIndividualORGSENIOR CITIZEN4334UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.GR Other Government OfficeMisrepresentationNoNo Jurisdiction2012-08-22T00:00:002012-09-18T00:00:00Medicare HMOAccident and HealthIndividual A & HInsured3425Health Maintenance OrgOrganizationORGSENIOR CITIZEN4334WATERS, JAMESGR Other Government OfficeMisrepresentationNo2012-08-22T00:00:002012-09-18T00:00:00Medicare HMOAccident and HealthIndividual A & HInsured1075140AgentIndividualORGSENIOR CITIZEN4335SELECTCARE OF TEXAS, L.L.C.GR Other Government OfficeMisrepresentationNoInformation Furnished2012-08-22T00:00:002012-12-18T00:00:00Medicare HMOAccident and HealthIndividual A & HAssociated Subject Company; Insured14275Health Maintenance OrgOrganizationORGSENIOR CITIZEN4335MEADOWS, ARTHUR SEMBERAGR Other Government OfficeMisrepresentationNoInformation Furnished2012-08-22T00:00:002012-12-18T00:00:00Medicare HMOAccident and HealthIndividual A & HAssociated Subject Company; Insured830332AgentIndividualORGSENIOR CITIZEN4336E & G DIVERSIFIED SERVICES ROOFING & REDMODELINGInsurance CompanyUnauthorized ActsYesOther2012-08-06T00:00:002012-10-13T00:00:00Property and CasualtyHomeownersHomeowners GroupInsured68238OtherOrganizationORG4337Air ContractorsInsurance CompanyUnauthorized ActsYesInformation Furnished2012-07-23T00:00:002012-09-25T00:00:00Property and CasualtyHomeownersHomeownersInsured68239OtherOrganizationORG4337HADLEY, RICKY LEEInsurance CompanyUnauthorized ActsYesInsufficient Information2012-07-23T00:00:002012-09-25T00:00:00Property and CasualtyHomeownersHomeownersInsured1079172Claims AdjusterIndividualORG4338UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.GR Other Government OfficeMisrepresentationNoNo Jurisdiction2012-08-22T00:00:002012-09-13T00:00:00Medicare HMOAccident and HealthIndividual A & HInsured14666Health Maintenance OrgOrganizationORGSENIOR CITIZEN4338STRANG, CHRISTA ALYSEGR Other Government OfficeMisrepresentationNoInformation Furnished2012-08-22T00:00:002012-09-13T00:00:00Medicare HMOAccident and HealthIndividual A & HInsured717331AgentIndividualORGSENIOR CITIZEN4339UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.GR Other Government OfficeMisrepresentationNoInformation Furnished2012-08-22T00:00:002012-09-19T00:00:00Medicare HMOAccident and HealthIndividual A & HInsured3425Health Maintenance OrgOrganizationORGSENIOR CITIZEN4339WATTS, JAMES KEVINGR Other Government OfficeAgent Handling; MisrepresentationNoInformation Furnished2012-08-22T00:00:002012-09-19T00:00:00Medicare HMOAccident and HealthIndividual A & HInsured1101546AgentIndividualORGSENIOR CITIZEN4340AMERICAN-AMICABLE LIFE INSURANCE COMPANY OF TEXASRelativeCash ValueNoInformation Furnished2012-08-13T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured745Ins Co - Licensed/ActiveOrganizationINDV4341First Choice HealthcareInsuredMisleading AdvertisingNoReferred To2012-08-13T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H68406OtherOrganizationINDV4342FOREMOST COUNTY MUTUAL INSURANCE COMPANYConsumer (Non-Insured)Unsatisfactory Settle/OfferNoAdditional Payment Expected; Contract Language/Legal Issue; Information Furnished2012-08-06T00:00:002012-10-23T00:00:00Property and CasualtyHomeownersMobile Homeowner2530Ins Co - Licensed/ActiveOrganizationORG4343AXS HEALTH INSURANCE AGENCY, A LIMITED LIABILITY COMPANYInsuredRefund Of PremiumNoInformation Furnished2012-08-10T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H35853Ins Co - Licensed/ActiveOrganizationINDV4344DRIVER'S INSURANCE COMPANYConsumer (Non-Insured)Cust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferNoRecord Only2012-08-06T00:00:002012-11-27T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Person2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; LOSS OF USE4345BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDelays (Claims Handling); Unsatisfactory Settle/Offer; Usual And CustomaryNoContract Language/Legal Issue; Additional Monies Received2012-08-21T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationINDV4346HUMANA INSURANCE COMPANYGR Other Government OfficeMisrepresentationNoInformation Furnished2012-08-22T00:00:002012-09-13T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1040Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN4346STEENHOEK, PAMELA LYNNGR Other Government OfficeMisrepresentationNoInformation Furnished2012-08-22T00:00:002012-09-13T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured744213AgentIndividualORGSENIOR CITIZEN4347HUMANA INSURANCE COMPANYGR Other Government OfficeMisrepresentationNoInformation Furnished2012-08-22T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1040Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN4347ONEILL, DAVID ROBERTGR Other Government OfficeMisrepresentationNo2012-08-22T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured481172AgentIndividualORGSENIOR CITIZEN4348FIRST HEALTH LIFE & HEALTH INSURANCE COMPANYGR Other Government OfficeMisrepresentationNoInformation Furnished2012-08-22T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured962Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN4349CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANYGR Other Government OfficeMisrepresentationNoInformation Furnished2012-08-22T00:00:002012-10-04T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured25422Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN4349FLORES, ALEJANDRO MANUELGR Other Government OfficeMisrepresentationYesInformation Furnished2012-08-22T00:00:002012-10-04T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured447183AgentIndividualORGSENIOR CITIZEN4350HUMANA INSURANCE COMPANYGR Other Government OfficeMisrepresentationNoNo Jurisdiction2012-08-22T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1040Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN4350SANFILIPPO, ANGELIAGR Other Government OfficeMisrepresentationNoInformation Furnished2012-08-22T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1075361AgentIndividualORGSENIOR CITIZEN4351HUMANA INSURANCE COMPANYGR Other Government OfficeMisrepresentationNoNo Jurisdiction2012-08-22T00:00:002012-09-13T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1040Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN4351RIOS, ISABELGR Other Government OfficeMisrepresentationNoInformation Furnished2012-08-22T00:00:002012-09-13T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1073317AgentIndividualORGSENIOR CITIZEN4352CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANYGR Other Government OfficeMisrepresentationNoNo Jurisdiction2012-08-22T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured25422Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN4352BANGS, TROY ROBERTGR Other Government OfficeMisrepresentationYesInformation Furnished2012-08-22T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured770070AgentIndividualORGSENIOR CITIZEN4353CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANYGR Other Government OfficeMisrepresentationNoInformation Furnished2012-08-22T00:00:002012-10-04T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured25422Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN4353CHIZK, ROSEMARY VIORAGR Other Government OfficeMisrepresentationYes2012-08-22T00:00:002012-10-04T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured123852AgentIndividualORGSENIOR CITIZEN4354UNITEDHEALTHCARE INSURANCE COMPANYGR Other Government OfficeDelays (Policyholder Service)NoNo Jurisdiction2012-08-22T00:00:002012-09-06T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1348Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN4355UNITEDHEALTHCARE INSURANCE COMPANYGR Other Government OfficeMisrepresentationNoNo Jurisdiction2012-08-22T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1348Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN4356HUMANA HEALTH PLAN OF TEXAS, INC.GR Other Government OfficeMisrepresentationNoInformation Furnished2012-08-22T00:00:002012-09-13T00:00:00Medicare HMOAccident and HealthIndividual A & HInsured702Health Maintenance OrgOrganizationORGSENIOR CITIZEN4356CALDERON, PHILLIP RGR Other Government OfficeMisrepresentationNoInformation Furnished2012-08-22T00:00:002012-09-13T00:00:00Medicare HMOAccident and HealthIndividual A & HInsured421572AgentIndividualORGSENIOR CITIZEN4357ARISAThird PartyDelays (Claims Handling); OtherYesOpened/Linked to Case File; Referred for Disciplinary Actn; Additional Monies Received2012-08-07T00:00:002012-11-19T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured; Insured Company68250Insurance AgencyOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation4358PRUDENTIAL INSURANCE COMPANY OF AMERICA, THEBeneficiaryDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-08-08T00:00:002012-10-15T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesDeceased Person1729Ins Co - Licensed/ActiveOrganizationINDV4359DRIVER'S INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-08-06T00:00:002012-10-04T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; MULTIPLE INSUREDS; POLICY EXCLUSION; UNCOOPERATIVE INSURED; UNDERWRITING CRITERIA4360BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-08-08T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured10047Ins Co - Licensed/ActiveOrganizationORGMULTIPLE INSUREDS4361SANTA FE AUTO INSURANCE COMPANYThird PartyLiability Dispute; Unsatisfactory Settle/OfferNoInformation Furnished2012-08-06T00:00:002012-09-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass27766Ins Co - Licensed/ActiveOrganizationINDV4362LOYA INSURANCE COMPANYThird PartyDelays (Claims Handling)YesInformation Furnished; Additional Monies Received2012-08-07T00:00:002012-10-02T00:00:00Property and CasualtyAutomobileIndividual Private Pass15643Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; LOSS OF USE4366BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction2012-08-08T00:00:002012-12-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Self-Funded / ErisaOrganizationORG4367BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction2012-08-08T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4368BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction2012-08-08T00:00:002012-10-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4369BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-08-08T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4370BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction2012-08-08T00:00:002012-10-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4371BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction2012-08-08T00:00:002012-10-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4372HUMANA INSURANCE COMPANYProviderDelays (Claims Handling)YesAdditional Monies Received; Information Furnished2012-08-08T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORG4373STATE FARM FIRE AND CASUALTY COMPANYInsuredOtherNoPolicy Issued/Restored; Information Furnished2012-08-06T00:00:002012-11-30T00:00:00Property and CasualtyMiscellaneousFederal Flood1507Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNDERWRITING CRITERIA4373GEOVERA SPECIALTY INSURANCE COMPANYInsuredOtherNoInformation Furnished2012-08-06T00:00:002012-11-30T00:00:00Property and CasualtyMiscellaneousFederal Flood56985Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNDERWRITING CRITERIA4373CLAYTON, RANDALL CRAIGInsuredAgent Handling; ConversionYesNo Enforcement Case Opened; Referred for Disciplinary Actn; Failure to Timely Respond2012-08-06T00:00:002012-11-30T00:00:00Property and CasualtyMiscellaneousFederal Flood231957AgentIndividualINDVCOVERAGE DISPUTE; UNDERWRITING CRITERIA4374REPUBLIC LLOYDSConsumer (Non-Insured)Unsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-08-06T00:00:002012-09-26T00:00:00Property and CasualtyHomeownersHomeownersInsured2299Ins Co - Licensed/ActiveOrganizationORGROOF4375STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXASLienholderDelays (Claims Handling); Liability DisputeNoInformation Furnished; Company Position Upheld2012-08-06T00:00:002012-09-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass1506Ins Co - Licensed/ActiveOrganizationORGTOTAL LOSS; UNDERWRITING CRITERIA4376GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Question of Fact; Information Furnished2012-08-06T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF4377METROPOLITAN LIFE INSURANCE COMPANYInsuredDelays (Claims Handling)YesContract Language/Legal Issue; No Jurisdiction2012-08-08T00:00:002012-10-11T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities13191Ins Co - Licensed/ActiveOrganizationINDV4378BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoInformation Furnished2012-08-08T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4379BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-08-08T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGBUNDLING4381CAPITOL COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredCancellation; Non-RenewalNoCancel/Non-Renewal Upheld; Information Furnished2012-08-06T00:00:002012-09-27T00:00:00Property and CasualtyHomeownersHomeowners2992Ins Co - Licensed/ActiveOrganizationINDVPOLICY EXCLUSION; UNDERWRITING CRITERIA4382BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction2012-08-08T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4383PEERLESS INDEMNITY INSURANCE COMPANYConsumer (Non-Insured)Delays (Claims Handling)NoInformation Furnished; Additional Monies Received; Additional Payment Expected2012-08-06T00:00:002012-10-31T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company; Associated Subject Person47997Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; BURDEN OF PROOF; WATER DAMAGE4384GRAMERCY INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-08-06T00:00:002012-09-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass1062Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation; LOSS OF USE; REPLACEMENT VEHICLE4385GLOBAL HAWK INSURANCE COMPANY, A RISK RETENTION GROUPConsumer (Non-Insured)Delays (Claims Handling)NoAdditional Monies Received2012-08-06T00:00:002012-10-04T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Associated Subject Agency; Associated Subject Person; Insured Company53416Ins Co - Licensed/ActiveOrganizationINDV4386FIRE INSURANCE EXCHANGEInsuredPremium and RatingNoCompany Position Upheld; Information Furnished2012-08-06T00:00:002012-10-03T00:00:00Property and CasualtyHomeownersHomeowners2606Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA4387LIBERTY INSURANCE CORPORATIONInsuredCust Service Claim Handling; Denial Of Claim; Unfair Discrim-Clms HandlingYesCompany Position Upheld; Information Furnished2012-08-06T00:00:002013-10-08T00:00:00Property and CasualtyHomeownersHomeowners3636Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA4388DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling)NoCompany Position Upheld; Information Furnished; Additional Payment Expected2012-08-06T00:00:002012-09-27T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation4391TRUCK INSURANCE EXCHANGEInsuredCust Service Claim Handling; Delays (Claims Handling)YesClaim Settled; Information Furnished; Additional Monies Received2012-08-07T00:00:002012-10-03T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines1355Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; HAIL; LOSS OF USE; ROOF4392GEICO INDEMNITY COMPANYThird PartyDelays (Claims Handling); Liability DisputeNoAdditional Monies Received; Question of Fact2012-08-07T00:00:002012-11-21T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured2785Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COMPARATIVE NEGLIGENCE; GR-Claim Evaluation; LOSS OF USE4393AMERICAN FAMILY LIFE ASSURANCE COMPANY OF COLUMBUSInsuredDenial Of ClaimNoContract Language/Legal Issue; Insufficient Information2012-08-22T00:00:002012-09-11T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HGR Elected Official2655Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation4394STATE AUTO PROPERTY & CASUALTY INSURANCE COMPANYConsumer (Non-Insured)OtherNoInformation Furnished2012-08-23T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Deceased Person; Insured28439Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA4395SAFECO INSURANCE COMPANY OF INDIANAInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-08-06T00:00:002012-10-18T00:00:00Property and CasualtyHomeownersHomeowners2496Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; ROOF4396UNITRIN COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)YesClaim Settled; Information Furnished2012-08-07T00:00:002012-11-16T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1856Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation4397SAFECO INSURANCE COMPANY OF INDIANAInsuredCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferYesClaim Settled; Information Furnished2012-08-07T00:00:002012-10-03T00:00:00Property and CasualtyHomeownersHomeowners2496Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; WATER DAMAGE4398ACCC INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling); Denial Of ClaimNoCompany Position Upheld; Information Furnished2012-08-07T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation4399TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-08-06T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass1450Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COMPARATIVE NEGLIGENCE; COVERAGE DISPUTE4400TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICAThird PartyUnsatisfactory Settle/OfferYesClaim Settled; Information Furnished2012-08-07T00:00:002012-10-03T00:00:00Property and CasualtyAutomobileTruckers PolicyAssociated Agent; Associated Subject Company1345Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; TAXES4401HOMEOWNERS OF AMERICA INSURANCE COMPANYInsuredPremium and RatingNoCompany Position Upheld; Information Furnished2012-08-06T00:00:002012-10-03T00:00:00Property and CasualtyHomeownersHomeowners25247Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA4402UNITED OF OMAHA LIFE INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished; Contract Language/Legal Issue2012-08-23T00:00:002012-10-08T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1281Ins Co - Licensed/ActiveOrganizationINDV4403AMERICAN NATIONAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled2012-08-08T00:00:002012-10-30T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person135Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation4404GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-08-07T00:00:002012-10-04T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent32363Ins Co - Licensed/ActiveOrganizationINDVACV; DAMAGE DISPUTE; GR-Claim Evaluation; LOSS OF USE; REPLACEMENT VEHICLE; TOTAL LOSS4405CAPITOL COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferYesAdditional Monies Received2012-07-30T00:00:002012-11-14T00:00:00Property and CasualtyHomeownersHomeowners2992Ins Co - Licensed/ActiveOrganizationINDVROOF; SENIOR CITIZEN4406OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoAdditional Payment Expected; Information Furnished2012-08-07T00:00:002012-10-04T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; DIMINISHED VALUE4407STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredRefund Of PremiumYesInformation Furnished; Premium Refunded2012-07-30T00:00:002012-09-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA4409STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXASLienholderRecoupment Of Claims PaymentYesInformation Furnished; Additional Monies Received2012-08-07T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1506Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; HAIL; TOTAL LOSS4410SOUTHERN COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and RatingNoCompany Position Upheld; Information Furnished2012-07-30T00:00:002012-09-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass1583Ins Co - Licensed/ActiveOrganizationINDV4411HARTFORD LIFE AND ANNUITY INSURANCE COMPANYInsuredRefund Of PremiumNoContract Language/Legal Issue; Information Furnished2012-08-08T00:00:002012-10-24T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2328Ins Co - Licensed/ActiveOrganizationINDV4412MERCURY COUNTY MUTUAL INSURANCE COMPANYInsuredLiability Dispute; Unsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-08-07T00:00:002012-10-04T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1693Ins Co - Licensed/ActiveOrganizationINDVLOSS OF USE; REPLACEMENT VEHICLE4413DRIVER'S INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Question of Fact2012-07-30T00:00:002012-09-20T00:00:00Property and CasualtyAutomobileIndividual Private Pass2038Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNCOOPERATIVE INSURED4415LIBERTY COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimYesCompany Position Upheld; Additional Monies Received; Policy Not In Force2012-08-07T00:00:002012-12-06T00:00:00Property and CasualtyAutomobileIndividual Private Pass3762Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE4416ALLSTATE INDEMNITY COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld2012-08-07T00:00:002012-09-28T00:00:00Property and CasualtyHomeownersRental167Ins Co - Licensed/ActiveOrganizationINDVHAIL; OVERHEAD AND PROFIT; ROOF4417STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoContract Language/Legal Issue; Information Furnished; Additional Payment Expected2012-08-07T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV4418ALLSTATE LIFE INSURANCE COMPANYRelativeDelays (Policyholder Service)NoInformation Furnished2012-08-07T00:00:002012-10-22T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured169Ins Co - Licensed/ActiveOrganizationINDV4419OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferNoInformation Furnished2012-08-07T00:00:002012-10-04T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; DAMAGE DISPUTE; GR-Claim Evaluation; REPLACEMENT VEHICLE; TOTAL LOSS4420TEXAS FARM BUREAU CASUALTY INSURANCE COMPANYInsuredCust Service Claim Handling; Denial Of ClaimNoInformation Furnished; Company Position Upheld2012-08-07T00:00:002012-10-05T00:00:00Property and CasualtyAutomobileIndividual Private Pass28440Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation4421WASHINGTON NATIONAL INSURANCE COMPANYInsuredPremium NoticeNoContract Language/Legal Issue2012-08-23T00:00:002012-10-22T00:00:00Property and CasualtyLife & AnnuityIndividual Life1196Ins Co - Licensed/ActiveOrganizationINDV4422ALLSTATE TEXAS LLOYD'SInsuredDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; Complainant Retained Attorney; Additional Monies Received2012-08-06T00:00:002012-10-10T00:00:00Property and CasualtyHomeownersHomeowners3721Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF4424AETNA LIFE INSURANCE COMPANYPhysicianUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-08T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDV4426AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished2012-08-08T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDV4427USAA CASUALTY INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue2012-08-07T00:00:002012-11-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass3607Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED4428LIBERTY COUNTY MUTUAL INSURANCE COMPANYThird PartyCust Service Claim Handling; Unsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-08-07T00:00:002012-10-10T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured3762Ins Co - Licensed/ActiveOrganizationINDV4429STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredDenial Of ClaimYesInformation Furnished; Claim Settled2012-08-07T00:00:002012-11-16T00:00:00Property and CasualtyMiscellaneousWatercraftAssociated Subject Person1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; UNDERWRITING CRITERIA4430UNITRIN COUNTY MUTUAL INSURANCE COMPANYInsuredCust Service Claim HandlingNoInformation Furnished2012-08-06T00:00:002012-10-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass1856Ins Co - Licensed/ActiveOrganizationINDV4431STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredRefund Of PremiumNoCompany Position Upheld2012-08-07T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent1510Ins Co - Licensed/ActiveOrganizationINDV4432USAA GENERAL INDEMNITY COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Company Position Upheld2012-08-07T00:00:002012-10-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass1276Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; LOSS OF USE; REPLACEMENT VEHICLE4433HOME STATE COUNTY MUTUAL INSURANCE COMPANYOtherDelays (Claims Handling)NoClaim Settled2012-08-07T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency2362Ins Co - Licensed/ActiveOrganizationORG4434CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-08T00:00:002012-10-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Self-Funded / ErisaOrganizationINDV4436STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDelays (Claims Handling)YesClaim Settled; Information Furnished; Additional Monies Received2012-08-07T00:00:002012-12-18T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING4437BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished2012-08-08T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDVMULTIPLE INSUREDS4438ALLSTATE TEXAS LLOYD'SInsuredDenial Of ClaimNoCompany Position Upheld; Referred To; Information Furnished2012-08-08T00:00:002012-10-31T00:00:00Property and CasualtyHomeownersHomeowners3721Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF4439GERMANIA FARM MUTUAL INSURANCE ASSOCIATIONInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld; Question of Fact2012-08-07T00:00:002012-10-19T00:00:00Property and CasualtyHomeownersHomeowners2468Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; DEDUCTIBLE; GR-Claim Evaluation4440OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDenial Of ClaimNoAdditional Payment Expected2012-08-08T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company1823Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation; TOTAL LOSS4440A-AFFORDABLE INSURANCE AGENCY, INC.InsuredAgent HandlingYesInformation Furnished2012-08-08T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company15268AgentOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation; TOTAL LOSS4441LOYA INSURANCE COMPANYConsumer (Non-Insured)Delays (Claims Handling); Denial Of ClaimNoCompany Position Upheld; Information Furnished2012-08-06T00:00:002012-10-18T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured15643Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; NAMED DRIVER POLICY; POLICY EXCLUSION; UNCOOPERATIVE INSURED4442TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredCancellationNoCancel/Non-Renewal Upheld; Information Furnished2012-08-08T00:00:002012-11-12T00:00:00Property and CasualtyHomeownersHomeowners1444TWIAOrganizationINDV4442CALDERON, JAVIERInsuredConversion; Refund Of PremiumYesInformation Furnished; Additional Monies Received; Premium Refunded2012-08-08T00:00:002012-11-12T00:00:00Property and CasualtyHomeownersHomeowners630415AgentIndividualINDV4443UNITED FIRE LLOYDSThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Complainant Retained Attorney; Additional Payment Expected2012-08-08T00:00:002012-11-02T00:00:00Property and CasualtyAutomobileBusiness AutomobileInsured; Insured Company3121Ins Co - Licensed/ActiveOrganizationINDVACV; GR-Claim Evaluation; LOSS OF USE; TOTAL LOSS4444FIRST HEALTH/TRAVELERS HCNRelativeContinuity Of Treatment; Primary Care Providr SelectionYesInformation Furnished2012-08-16T00:00:002012-10-24T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkInsured54191Ins Co - Licensed/ActiveOrganizationINDV4445STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoQuestion of Fact2012-08-08T00:00:002012-11-13T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person1510Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF; DAMAGE DISPUTE; GR-Claim Evaluation4446STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYConsumer (Non-Insured)Assignment of Benefits; Recoupment Of Claims PaymentNoInformation Furnished; Contract Language/Legal Issue2012-08-08T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV4447GEICO INDEMNITY COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoContract Language/Legal Issue; Company Position Upheld2012-08-08T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2785Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED4448TEXAS FARMERS INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld2012-08-08T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass1452Ins Co - Licensed/ActiveOrganizationINDV4449RANCHERS AND FARMERS INSURANCE COMPANYInsuredCust Service Claim Handling; Denial Of ClaimNoInformation Furnished; Company Position Upheld2012-08-08T00:00:002012-10-23T00:00:00Property and CasualtyHomeownersRentalAssociated Subject Person20264Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA4450UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesInformation Furnished; No Jurisdiction2012-08-08T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDVMULTIPLE INSUREDS4451GRIFFIN GENERAL AGENCY INCInsuredRefund Of PremiumYesCorrective Action Taken; Information Furnished2012-08-08T00:00:002012-10-12T00:00:00Property and CasualtyHomeownersHomeowners4712AgentOrganizationINDV4454LIBERTY HEALTH CARE NETWORKNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-08-20T00:00:002012-10-26T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkCorrespondent Person; Injured Employee54531WC Healthcare Provider NtwkOrganizationORG4455LIBERTY LIFE ASSURANCE COMPANY OF BOSTONInsuredCash Value; Delays (Policyholder Service)NoInformation Furnished2012-08-06T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2205Ins Co - Licensed/ActiveOrganizationINDV4456TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYInsuredEndorsement / RiderNoCompany Position Upheld2012-08-08T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass1450Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE4457OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoQuestion of Fact; Additional Monies Received2012-08-08T00:00:002012-10-05T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; LOSS OF USE4458BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONNon-Contracted ProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-08-06T00:00:002012-10-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4459HISCOX INSURANCE COMPANY INC.InsuredEndorsement / Rider; Premium and Rating; Refund Of PremiumNoContract Language/Legal Issue; Information Furnished2012-08-08T00:00:002012-11-28T00:00:00Property and CasualtyFire, Allied Lines & CMPBusiness OwnersAssociated Subject Agency; Correspondent Person122Ins Co - Licensed/ActiveOrganizationORGUNDERWRITING CRITERIA4460UNITED SERVICES AUTOMOBILE ASSOCIATIONLienholderDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-08-08T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1254Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation4461FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoCompany Position Upheld2012-08-08T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured2623Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation4462BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/Offer; Usual And CustomaryNoInformation Furnished2012-08-06T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4463GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferYesCompany Position Upheld; Additional Monies Received; Information Furnished2012-08-08T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation4464SAFECO INSURANCE COMPANY OF INDIANAConsumer (Non-Insured)Unsatisfactory Settle/OfferNoInformation Furnished2012-08-08T00:00:002012-10-23T00:00:00Property and CasualtyHomeownersHomeownersInsured2496Ins Co - Licensed/ActiveOrganizationORGOVERHEAD AND PROFIT; ROOF4465UNITEDHEALTHCARE INSURANCE COMPANYRelativeCancellationNoPolicy Issued/Restored; Information Furnished2012-08-06T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN4466ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled; Information Furnished2012-08-08T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured9825Ins Co - Licensed/ActiveOrganizationINDV4467UNITEDHEALTHCARE INSURANCE COMPANYRelativeDenial Of ClaimYesClean Claims Violation; Information Furnished; Stat Pen Pd-46 To 90 Dys Late2012-08-24T00:00:002012-09-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV4468ACCC INSURANCE COMPANYAttorneyDenial Of ClaimNoCompany Position Upheld; Information Furnished2012-08-08T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; UNDERWRITING CRITERIA4469ALLSTATE INSURANCE COMPANYInsuredCancellation; Refund Of PremiumNoAdditional Monies Received; Premium Refunded2012-08-08T00:00:002012-10-12T00:00:00Property and CasualtyMiscellaneousFederal FloodAssociated Agent168Ins Co - Licensed/ActiveOrganizationINDV4470MedicaidProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-16T00:00:002012-08-27T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company67252Govermental EntityOrganizationINDV4471VISION INSURANCE COMPANYInsuredDelays (Policyholder Service); Identification Card IssueNoInformation Furnished; Company Position Upheld2012-08-08T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private Pass23478Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF; UNDERWRITING CRITERIA4472U S LLOYDS INSURANCE COMPANYConsumer (Non-Insured)Delays (Claims Handling); Denial Of ClaimNoAdditional Payment Expected; Information Furnished2012-08-08T00:00:002012-10-17T00:00:00Property and CasualtyHomeownersHomeowners3177Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; DAMAGE DISPUTE; HAIL; ROOF4473STATE FARM LLOYDSInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld; Additional Monies Received; Information Furnished2012-08-08T00:00:002012-10-18T00:00:00Property and CasualtyHomeownersCondominium3105Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation; WATER DAMAGE4474CONNECTICUT GENERAL LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Claim Settled2012-08-17T00:00:002012-09-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationINDV4475AMERICAN NATIONAL INSURANCE COMPANYInsuredPremium NoticeNoInformation Furnished2012-08-21T00:00:002012-10-09T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life135Ins Co - Licensed/ActiveOrganizationINDV4477FARM BUREAU COUNTY MUTUAL INSURANCE COMPANY OF TEXASRelativeMisrepresentationNo2012-08-10T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured1861Ins Co - Licensed/ActiveOrganizationINDV4477PYBURN, ALAN WADERelativeMisrepresentationNoInformation Furnished2012-08-10T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured134376AgentIndividualINDV4477WALLACE, CATHY ELAINERelativeMisrepresentationNo2012-08-10T00:00:002012-09-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured727222AgentIndividualINDV4479AMERICO FINANCIAL LIFE AND ANNUITY INSURANCE COMPANYConsumer (Non-Insured)Agent HandlingNoQuestion of Fact2012-08-13T00:00:002013-05-02T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company; Insured2897Ins Co - Licensed/ActiveOrganizationINDV4479WALLACE, CATHY ELAINEConsumer (Non-Insured)Agent HandlingNoQuestion of Fact; Information Furnished2012-08-13T00:00:002013-05-02T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company; Insured727222AgentIndividualINDV4480UNDERWRITERS AT LLOYD'S, LONDONInsuredDenial Of ClaimNoAdditional Payment Expected; Information Furnished2012-08-08T00:00:002012-10-10T00:00:00Property and CasualtyHomeownersCondominium55949Ins Co - Surplus LinesOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; POLICY EXCLUSION4482BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoClaim Settled2012-08-06T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4483UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesAdditional Monies Received2012-08-06T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4484TEXAS FARMERS INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-08-08T00:00:002012-10-16T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF4485ROSS, DANIEL GREGORYInsurance CompanyAgent HandlingYesOther2012-08-06T00:00:002012-09-11T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H669660AgentIndividualORG4486ALLSTATE INSURANCE COMPANYAgentOtherNoInsufficient Information2012-08-20T00:00:002012-11-13T00:00:00Property and CasualtyMiscellaneousNo Line Specified168Ins Co - Licensed/ActiveOrganizationINDV4486STATE FARM FIRE AND CASUALTY COMPANYAgentOtherNoInsufficient Information2012-08-20T00:00:002012-11-13T00:00:00Property and CasualtyMiscellaneousNo Line Specified1507Ins Co - Licensed/ActiveOrganizationINDV4486NATIONWIDE MUTUAL INSURANCE COMPANYAgentOtherNoInsufficient Information2012-08-20T00:00:002012-11-13T00:00:00Property and CasualtyMiscellaneousNo Line Specified1937Ins Co - Licensed/ActiveOrganizationINDV4486FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYAgentOtherNoInsufficient Information2012-08-20T00:00:002012-11-13T00:00:00Property and CasualtyMiscellaneousNo Line Specified2623Ins Co - Licensed/ActiveOrganizationINDV4486TEXAS FARM BUREAU CASUALTY INSURANCE COMPANYAgentOtherNoInsufficient Information2012-08-20T00:00:002012-11-13T00:00:00Property and CasualtyMiscellaneousNo Line Specified28440Ins Co - Licensed/ActiveOrganizationINDV4487CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-08T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Self-Funded / ErisaOrganizationORG4488PRIMERICA LIFE INSURANCE COMPANYInsuredPremium and RatingNoContract Language/Legal Issue; Information Furnished2012-08-08T00:00:002012-10-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2114Ins Co - Licensed/ActiveOrganizationINDV4489AETNA LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction2012-08-08T00:00:002012-10-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV4490SOUTHERN COUNTY MUTUAL INSURANCE COMPANYInsuredLiability DisputeNoInformation Furnished; Question of Fact2012-07-17T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass1583Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; SENIOR CITIZEN4491FARMERS NEW WORLD LIFE INSURANCE COMPANYInsuredCancellationNoInformation Furnished; Policy Not In Force2012-08-07T00:00:002012-10-16T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Agent2622Ins Co - Licensed/ActiveOrganizationINDV4492STATE AUTO PROPERTY & CASUALTY INSURANCE COMPANYOtherUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld; Additional Payment Expected2012-08-20T00:00:002012-10-03T00:00:00Property and CasualtyHomeownersHomeownersInsured28439Ins Co - Licensed/ActiveOrganizationORGDAMAGE DISPUTE; GR-Claim Evaluation; OVERHEAD AND PROFIT; ROOF4493BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDelays (Policyholder Service)YesPolicy Issued/Restored; Cancellation Withdrawn2012-08-08T00:00:002012-10-13T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life10047Ins Co - Licensed/ActiveOrganizationINDV4494UNITEDHEALTHCARE INSURANCE COMPANYInsuredMisrepresentationYesContract Language/Legal Issue; Policy Issued/Restored2012-08-08T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person1348Ins Co - Licensed/ActiveOrganizationORG4496HARTFORD LLOYD'S INSURANCE COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld2012-08-20T00:00:002012-10-09T00:00:00Property and CasualtyLiabilityGeneral Liability1017Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE4497Property Damage Restoration ServicesConsumer (Non-Insured)OtherNoInsufficient Information2012-07-25T00:00:002012-09-17T00:00:00Property and CasualtyHomeownersHomeowners67795Unauthorized ActivityOrganizationORG4499BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoInformation Furnished2012-08-08T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4500ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICAInsuredDelays (Policyholder Service)NoContract Language/Legal Issue; Information Furnished2012-08-08T00:00:002012-10-15T00:00:00Life, Accident and HealthLife & AnnuityIRA 910Ins Co - Licensed/ActiveOrganizationINDV4501RELIABLE LIFE INSURANCE COMPANY, THERelativeDelays (Claims Handling)NoInformation Furnished; Additional Monies Received2012-08-08T00:00:002012-10-23T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured1704Ins Co - Licensed/ActiveOrganizationINDV4502BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-08-08T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4503BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction2012-08-08T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Self-Funded / ErisaOrganizationORG4505BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoInformation Furnished2012-08-08T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGBUNDLING4506ALLSTATE TEXAS LLOYD'SInsuredCancellation; Denial Of ClaimNoAdditional Payment Expected; Contract Language/Legal Issue2012-07-27T00:00:002012-11-19T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent3721Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING4507BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoNo Jurisdiction2012-08-08T00:00:002012-10-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4508LIBERTY INSURANCE CORPORATIONInsuredDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-08-27T00:00:002012-10-18T00:00:00Property and CasualtyHomeownersHomeowners3636Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation; WATER DAMAGE4509BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoCompany Position Upheld2012-08-08T00:00:002012-09-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4510PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYConsumer (Non-Insured)Unsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished2012-08-08T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVTOTAL LOSS4511AETNA LIFE INSURANCE COMPANYPhysicianUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-08-08T00:00:002012-10-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured245Ins Co - Licensed/ActiveOrganizationINDV4512UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling); Prompt PayYesStat Pen Pd-46 To 90 Dys Late; Additional Monies Received; Failure to Timely Respond2012-08-08T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4513DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimYesQuestion of Fact; Information Furnished2012-08-08T00:00:002012-10-09T00:00:00Property and CasualtyAutomobileIndividual Private Pass2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation4514OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled; Information Furnished2012-08-08T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDV4515BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimYesAdditional Monies Received2012-08-27T00:00:002012-10-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4517CIGNA HEALTHCARE OF TEXAS, INC.Third PartyDelays (Claims Handling); SB418 Rule ViolationNoCompany Position Upheld; Information Furnished2012-08-08T00:00:002012-10-22T00:00:00Health Maintenance OrgAccident and HealthGroup A&HAssociated Subject Company; Insured8294Health Maintenance OrgOrganizationORG4518UNITED SERVICES AUTOMOBILE ASSOCIATIONInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferYesAdditional Monies Received; Claim Settled2012-08-08T00:00:002012-12-07T00:00:00Property and CasualtyAutomobileIndividual Private Pass1254Ins Co - Licensed/ActiveOrganizationINDVAPPRAISAL; COVERAGE DISPUTE; DEDUCTIBLE; GR-Claim Evaluation4519DALLAS NATIONAL INSURANCE COMPANY, A TEXAS STOCK INSURANCE COMPANYConsumer (Non-Insured)Delays (Claims Handling)NoCompany Position Upheld2012-08-08T00:00:002012-10-30T00:00:00Property and CasualtyLiabilityGeneral LiabilityAssociated Agent; Associated Subject Company23880Ins Co - Licensed/ActiveOrganizationINDV4522UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-08-08T00:00:002012-10-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation4523OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished2012-08-08T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationORG4524TIME INSURANCE COMPANYProviderDelays (Claims Handling)NoInformation Furnished; Additional Monies Received2012-08-08T00:00:002012-11-14T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company; Associated Subject Person; Insured1374Ins Co - Licensed/ActiveOrganizationORG4524CIGNA HEALTH AND LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoInformation Furnished2012-08-08T00:00:002012-11-14T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company; Associated Subject Person; Insured1841Third Party AdministratorsOrganizationORG4525AMERICAN RISK INSURANCE COMPANY, INC.InsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Payment Expected; Contract Language/Legal Issue2012-08-08T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent27377Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; SUPPLEMENTARY PAYMENT4526NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA.InsuredDenial Of ClaimNoContract Language/Legal Issue2012-08-08T00:00:002012-12-10T00:00:00Property and CasualtyMiscellaneousP & C MiscThird Party Admin-Licensed1931Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation4527FARMERS INSURANCE EXCHANGEInsuredFraudNoOther2012-08-01T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company2668Ins Co - Licensed/ActiveOrganizationINDV4528GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Question of Fact2012-08-09T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2486Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; LOSS OF USE4529FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredCancellation; Denial Of ClaimNoCompany Position Upheld; Cancel/Non-Renewal Upheld; Information Furnished2012-08-08T00:00:002012-10-18T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2623Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation4530ACE PROPERTY AND CASUALTY INSURANCE COMPANYInsuredDelays (Claims Handling); Denial Of ClaimYesQuestion of Fact; Contract Language/Legal Issue2012-08-08T00:00:002012-11-23T00:00:00Property and CasualtyMiscellaneousFederal Crop244Ins Co - Licensed/ActiveOrganizationINDV4531UNITEDHEALTHCARE INSURANCE COMPANYInsuredCancellationNoNo Jurisdiction2012-08-08T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV4532Parlin, BrentInsurance CompanyOtherNoRecord Only; Insufficient Information2012-08-01T00:00:002012-11-21T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person1146691OtherIndividualORG4533GLOBE LIFE AND ACCIDENT INSURANCE COMPANYRelativeDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-08-07T00:00:002012-11-12T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person917Ins Co - Licensed/ActiveOrganizationINDVRESCISSION4534DAIRYLAND COUNTY MUTUAL INSURANCE COMPANY OF TEXASThird PartyDelays (Claims Handling); Liability Dispute; Unsatisfactory Settle/OfferNoClaim Settled2012-08-21T00:00:002012-11-09T00:00:00Property and CasualtyAutomobileIndividual Private Pass2737Ins Co - Licensed/ActiveOrganizationINDV4537REASSURE AMERICA LIFE INSURANCE COMPANYRelativeDelays (Claims Handling)NoInformation Furnished2012-08-27T00:00:002012-09-10T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1228Ins Co - Licensed/ActiveOrganizationINDV4538MORNING STAR CONTRACTORSAttorneyMisrepresentationYesOther2012-08-07T00:00:002012-10-24T00:00:00Property and CasualtyHomeownersHomeowners68322OtherOrganizationORGADVERTISING4539TAYLOR CONTRACTING/ROOFINGGR Other Government OfficeMisrepresentationYesOther2012-08-07T00:00:002012-10-22T00:00:00Property and CasualtyHomeownersHomeowners68323OtherOrganizationORGADVERTISING4540OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoClaim Settled2012-08-09T00:00:002012-11-23T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company1823Ins Co - Licensed/ActiveOrganizationINDV4541TEXAS FAIR PLAN ASSOCIATIONInsuredCancellation; Unfair DiscriminationNoContract Language/Legal Issue; Information Furnished2012-08-10T00:00:002012-10-17T00:00:00Property and CasualtyHomeownersHomeowners18208Texas Fair Insurance PlanOrganizationINDV4542STATE FARM LLOYDSInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received; Claim Settled2012-08-10T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; HAIL; ROOF; UNDERWRITING CRITERIA; WATER DAMAGE4545AAA TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/Offer; Use Of Clue ReportsNoInformation Furnished; Question of Fact2012-08-10T00:00:002013-03-25T00:00:00Property and CasualtyAutomobileIndividual Private Pass2286Ins Co - Licensed/ReceivershipOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF; DAMAGE DISPUTE; UNDERWRITING CRITERIA4546APPALACHIAN UNDERWRITERS, INC.InsuredRefund Of PremiumNoContract Language/Legal Issue2012-08-10T00:00:002012-10-25T00:00:00Property and CasualtyHomeownersHomeownersInsured Company26853Insurance AgencyOrganizationINDV4546CISNEROS, LEONARD RONALDInsuredAgent HandlingNoInformation Furnished2012-08-10T00:00:002012-10-25T00:00:00Property and CasualtyHomeownersHomeownersInsured Company104554AgentIndividualINDV4547VOYAGER INDEMNITY INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling)NoQuestion of Fact; Information Furnished2012-08-10T00:00:002012-10-23T00:00:00Property and CasualtyHomeownersMobile Homeowner51916Ins Co - Surplus LinesOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; UNDERWRITING CRITERIA4548STEWART TITLE GUARANTY COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-08-10T00:00:002012-11-06T00:00:00Property and CasualtyMiscellaneousTitle Insurance48783Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation4549FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Underwriting); Premium and RatingNoInformation Furnished; Company Position Upheld2012-08-10T00:00:002012-10-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA4550AMERICAN RISK INSURANCE COMPANY, INC.InsuredCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferNoQuestion of Fact; Contract Language/Legal Issue; Information Furnished2012-08-10T00:00:002012-10-25T00:00:00Property and CasualtyHomeownersHomeowners27377Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation; ROOF; WATER DAMAGE4552SOUTHERN COUNTY MUTUAL INSURANCE COMPANYInsuredCancellation; Misleading AdvertisingYesInformation Furnished2012-08-10T00:00:002012-11-06T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1583Ins Co - Licensed/ActiveOrganizationINDV4553OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDelays (Claims Handling)NoAdditional Payment Expected; Information Furnished2012-08-10T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING4554STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredUnfair Discrim-Clms Handling; Unsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld; Complainant Retained Attorney2012-08-10T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation4555TEXAS FARMERS INSURANCE COMPANYInsuredDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; Question of Fact2012-08-10T00:00:002012-10-12T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent1452Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; ROOF; UNDERWRITING CRITERIA; WATER DAMAGE4556ARISA INTERNATIONALConsumer (Non-Insured)Denial Of ClaimYesNo Jurisdiction; Apparent Unlicensed Activity; Information Furnished2012-08-10T00:00:002012-12-05T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured68331Unauthorized ActivityOrganizationINDV4557MID-CENTURY INSURANCE COMPANYInsuredPremium and RatingNoContract Language/Legal Issue; Information Furnished2012-08-10T00:00:002012-10-12T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied LinesAssociated Subject Company2085Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNDERWRITING CRITERIA4558WELLCARE OF TEXAS, INC.InsuredMisrepresentationNoNo Jurisdiction2012-08-22T00:00:002012-10-27T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HCorrespondent Company28079Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN4558GOMEZ, PETER NATHANIELInsuredAgent Handling; MisrepresentationNoQuestion of Fact2012-08-22T00:00:002012-10-27T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HCorrespondent Company802030AgentIndividualINDVSENIOR CITIZEN4559FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)NoInformation Furnished2012-08-20T00:00:002012-09-07T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING4560SOUTHERN COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished2012-08-10T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1583Ins Co - Licensed/ActiveOrganizationINDV4561GERMANIA INSURANCE COMPANYAgentDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received; Claim Settled2012-08-10T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured1159Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF4563FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyLiability Dispute; Unsatisfactory Settle/OfferNoQuestion of Fact; Claim Settled2012-08-10T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COMPARATIVE NEGLIGENCE; GR-Claim Evaluation4565UNDERWRITERS AT LLOYD'S, LONDONInsuredDelays (Claims Handling)NoContract Language/Legal Issue; Information Furnished; Additional Payment Expected2012-08-09T00:00:002012-10-17T00:00:00Property and CasualtyHomeownersHomeowners55949Ins Co - Surplus LinesOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; WATER DAMAGE4566ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received; Question of Fact; Information Furnished2012-08-10T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency9825Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF4567REDWOOD FIRE AND CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Claim Settled; Additional Monies Received2012-08-10T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent1114Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING4568OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoClaim Settled; Information Furnished2012-08-10T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation; HAIL; TOTAL LOSS4569OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyOverchargesYesInformation Furnished; Additional Monies Received; Referred for Disciplinary Actn2012-08-10T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company1823Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA4571BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoAdditional Monies Received2012-08-08T00:00:002012-10-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV4575OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; Company Position Upheld2012-08-10T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; UNCOOPERATIVE INSURED4576GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyDenial Of ClaimYesAdditional Payment Expected; Information Furnished2012-08-09T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation4577USAA TEXAS LLOYD'S COMPANYAgentDelays (Claims Handling)NoClaim Settled2012-08-10T00:00:002012-10-19T00:00:00Property and CasualtyHomeownersHomeownersInsured14630Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING4578UNIVERSAL NORTH AMERICA INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferYesClaim Settled2012-08-09T00:00:002012-11-12T00:00:00Property and CasualtyHomeownersHomeowners23526Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation4579DRIVER'S INSURANCE COMPANYAttorneyCust Service Claim Handling; Delays (Claims Handling)YesInformation Furnished2012-08-10T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING4581UNITED SERVICES AUTOMOBILE ASSOCIATIONThird PartyCust Service Claim Handling; Delays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-08-09T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured1254Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED4582UNITEDHEALTHCARE INSURANCE COMPANYSenior CitizenAgent Handling; Cancellation; MisrepresentationNoContract Language/Legal Issue2012-08-22T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company1348Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN4582THIBAUDEAU, NATHAN JSenior CitizenAgent Handling; MisrepresentationNoNo Jurisdiction2012-08-22T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company771194AgentIndividualINDVSENIOR CITIZEN4585UNITRIN COUNTY MUTUAL INSURANCE COMPANYInsuredRefund Of PremiumYesInformation Furnished2012-08-09T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass1856Ins Co - Licensed/ActiveOrganizationINDV4587STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-08-09T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV4588ATLANTIC CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Additional Payment Expected2012-03-15T00:00:002012-09-19T00:00:00Property and CasualtyLiabilityGeneral Liability52002Ins Co - Licensed/ActiveOrganizationINDV4592GERMANIA FARM MUTUAL INSURANCE ASSOCIATIONInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld; Question of Fact2012-08-20T00:00:002012-10-03T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent2468Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; HAIL; OVERHEAD AND PROFIT; ROOF; WATER DAMAGE4593CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANYSenior CitizenAgent Handling; MisrepresentationNoNo Jurisdiction2012-08-22T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Agent; Correspondent Company25422Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN4594PACIFIC SPECIALTY PROPERTY AND CASUALTY COMPANYInsuredDelays (Claims Handling)NoAdditional Payment Expected; Information Furnished2012-08-09T00:00:002012-10-12T00:00:00Property and CasualtyHomeownersRental15084Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; LOSS OF USE4595ENCOMPASS INDEMNITY COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld; Information Furnished2012-08-09T00:00:002012-10-13T00:00:00Property and CasualtyHomeownersHomeowners15014Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation; SUBROGATION4597HUMANA INSURANCE COMPANYSenior CitizenAgent Handling; MisrepresentationNoNo Jurisdiction2012-08-22T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Agent; Correspondent Company1040Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN4599PHYSICIANS HEALTH CHOICE OF TEXAS, LLCSenior CitizenAgent Handling; MisrepresentationNoNo Jurisdiction2012-08-22T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Agent; Correspondent Company17170Health Maintenance OrgOrganizationINDVSENIOR CITIZEN4600BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Company Position Upheld2012-08-08T00:00:002012-10-13T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured10047Ins Co - Licensed/ActiveOrganizationINDV4602UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.Senior CitizenAgent Handling; MisrepresentationNoNo Jurisdiction2012-08-22T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Agent; Correspondent Company14666Health Maintenance OrgOrganizationINDVSENIOR CITIZEN4603BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferYesContract Language/Legal Issue; Information Furnished2012-08-08T00:00:002012-09-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4605HUMANA INSURANCE COMPANYSenior CitizenMisrepresentationNoContract Language/Legal Issue2012-08-22T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Agent; Correspondent Company1040Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN4606BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-08-08T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGMULTIPLE INSUREDS4608HUMANA INSURANCE COMPANYInsuredMisrepresentationNoNo Jurisdiction2012-08-22T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company1040Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN4610BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-08-08T00:00:002012-10-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Self-Funded / ErisaOrganizationORGMULTIPLE INSUREDS4613CONSUMERS COUNTY MUTUAL INSURANCE COMPANYInsuredLiability DisputeNoQuestion of Fact; Company Position Upheld2012-08-09T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileIndividual Private Pass2806Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation4615PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeNoQuestion of Fact; Information Furnished2012-08-09T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1708Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF; GR-Claim Evaluation4617BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-08-08T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGGRANDFATHERED HEALTH PLAN; MULTIPLE INSUREDS4620BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-08-08T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4622BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-08-08T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGMULTIPLE INSUREDS4624LINCOLN NATIONAL LIFE INSURANCE COMPANY, THEInsuredUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction; Contract Language/Legal Issue2012-08-08T00:00:002012-10-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2172Ins Co - Licensed/ActiveOrganizationINDV4626CONNECTICUT GENERAL LIFE INSURANCE COMPANYInsuredMedical NecessityNoNo Jurisdiction2012-08-08T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Self-Funded / ErisaOrganizationINDV4627HUMANA INSURANCE COMPANYSenior CitizenMisrepresentationNoNo Jurisdiction2012-08-22T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company1040Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN4628UNITEDHEALTHCARE INSURANCE COMPANYHospitalDelays (Claims Handling)NoNo Jurisdiction2012-08-08T00:00:002012-10-09T00:00:00Medicare HMOAccident and HealthIndividual A & HInsured1348Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN4629HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.InsuredAgent Handling; MisrepresentationNoNo Jurisdiction2012-08-22T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company27417Health Maintenance OrgOrganizationINDVSENIOR CITIZEN4629TREVINO, ANTONIO ERAQUIOInsuredAgent Handling; MisrepresentationNoContract Language/Legal Issue2012-08-22T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company715962AgentIndividualINDVSENIOR CITIZEN4632UNITEDHEALTHCARE INSURANCE COMPANYHospitalDelays (Claims Handling)NoNo Jurisdiction2012-08-08T00:00:002012-10-09T00:00:00Medicare HMOAccident and HealthIndividual A & HInsured1348Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN4634CONNECTICUT GENERAL LIFE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished2012-08-10T00:00:002012-10-13T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2851Ins Co - Licensed/ActiveOrganizationINDV4635ALLSTATE TEXAS LLOYD'SInsuredDelays (Claims Handling)NoAdditional Monies Received2012-08-09T00:00:002012-11-19T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person3721Ins Co - Licensed/ActiveOrganizationINDV4638BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDelays (Claims Handling)NoOther2012-08-10T00:00:002012-08-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV4639HUMANA INSURANCE COMPANYProviderDelays (Claims Handling); Timely Filing DeficiencyNoClaim Not Clean; Contract Language/Legal Issue; Additional Monies Received2012-08-10T00:00:002013-01-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORGBUNDLING; GR-Claim Evaluation4643UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-10T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4646BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoInformation Furnished2012-08-08T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Associated Subject Person10047Ins Co - Licensed/ActiveOrganizationINDV4647Simply Retire Me InsuranceConsumer (Non-Insured)Misleading AdvertisingYes2012-08-10T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&H68367OtherOrganizationINDVADVERTISING4647RIVERA, MARCOS XAVIERConsumer (Non-Insured)Misleading AdvertisingYesInsufficient Information2012-08-10T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&H905577AgentIndividualINDVADVERTISING4649CHESAPEAKE LIFE INSURANCE COMPANY, THEInsuredDelays (Policyholder Service)NoInformation Furnished; Contract Language/Legal Issue2012-08-10T00:00:002012-10-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2924Ins Co - Licensed/ActiveOrganizationINDVGRANDFATHERED HEALTH PLAN; PRESCRIPTION4650HUMANA INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-08-09T00:00:002012-09-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation4651CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-10T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORG4652BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDelays (Policyholder Service); Premium NoticeYesAdditional Monies Received2012-08-10T00:00:002012-10-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV4655MTL INSURANCE COMPANYInsuredAgent Handling; MisrepresentationNoInformation Furnished; Contract Language/Legal Issue2012-08-08T00:00:002012-10-22T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Agent874Ins Co - Licensed/ActiveOrganizationINDV4655SHUMWAY, MICHAEL DAVIDInsuredAgent Handling; MisrepresentationNoInformation Furnished2012-08-08T00:00:002012-10-22T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Agent66562AgentIndividualINDV4656UMR, INC.HospitalDelays (Claims Handling)NoNo Jurisdiction2012-08-10T00:00:002012-10-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured23490Third Party AdministratorsOrganizationORG4659BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished2012-08-10T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4663BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished; Question of Fact2012-08-10T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation4664STATE FARM LIFE INSURANCE COMPANYInsuredNon-RenewalNoInformation Furnished2012-08-10T00:00:002012-10-23T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Agency1509Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNDERWRITING CRITERIA4667STARR INDEMNITY & LIABILITY COMPANYInsuredDelays (Claims Handling); Pre-Existing ConditionNoInformation Furnished2012-08-10T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&H997Ins Co - Licensed/ActiveOrganizationINDV4668HUMANA INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-10T00:00:002012-10-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Self-Funded / ErisaOrganizationORG4672AMERICAN GENERAL LIFE AND ACCIDENT INSURANCE COMPANYInsuredCash Value; Premium NoticeNoPolicy Not In Force; Contract Language/Legal Issue2012-08-10T00:00:002013-09-11T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1967Ins Co - Licensed/ActiveOrganizationINDV4673MAHONEY, DAVID MEADInsuredCancellation; Delays (Underwriting); Duplication of CoverageNoInformation Furnished2012-08-10T00:00:002012-10-22T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured Company647988AgentIndividualINDVCOVERAGE DISPUTE4676AMERICAN EQUITY INVESTMENT LIFE INSURANCE COMPANYInsuredDelays (Policyholder Service)NoContract Language/Legal Issue2012-08-09T00:00:002012-10-17T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesDeceased Person839Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN4676BARBARA, DANIEL PAULInsuredAgent Handling; MisrepresentationNoInformation Furnished2012-08-09T00:00:002012-10-17T00:00:00Life, Accident and HealthLife & AnnuityIndividual AnnuitiesDeceased Person527083AgentIndividualINDVSENIOR CITIZEN4678UNITEDHEALTHCARE INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-08T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV4680MOLINA HEALTHCARE OF TEXAS, INC.ProviderDenial Of ClaimYesInformation Furnished; Additional Payment Expected2012-08-09T00:00:002012-10-17T00:00:00Children Health Insurance PlanAccident and HealthGroup A&HInsured23469Health Maintenance OrgOrganizationORG4684Preexisting Condition Insurance PlanProviderOtherNoNo Jurisdiction2012-08-09T00:00:002012-08-29T00:00:00Life, Accident and HealthAccident and HealthXX-State SpecificInsured67818Govermental EntityOrganizationORGFEDERAL HEALTH CARE REFORM4686BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction; Contract Language/Legal Issue2012-08-09T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Self-Funded / ErisaOrganizationORG4688BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-08-09T00:00:002012-10-15T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4690BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-09T00:00:002012-10-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Self-Funded / ErisaOrganizationORG4693BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-09T00:00:002012-10-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4695BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-08-09T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Self-Funded / ErisaOrganizationORG4700BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-08-09T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG4702HUMANA INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished; Claim Not Clean2012-08-09T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORG4706INFINITY COUNTY MUTUAL INSURANCE COMPANYInsuredCancellation; Delays (Policyholder Service); Denial Of ClaimYesInformation Furnished; Cancellation Withdrawn2012-07-24T00:00:002012-09-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass1197Ins Co - Licensed/ActiveOrganizationINDV4706GONZALEZ, PRINCESSAInsuredAgent HandlingNoInformation Furnished2012-07-24T00:00:002012-09-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass992492AgentIndividualINDV4707HUMANA INSURANCE COMPANYOtherUnsatisfactory Settle/OfferYesClean Claims Violation; Additional Monies Received2012-08-09T00:00:002012-12-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORG4709UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-09T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Self-Funded / ErisaOrganizationORG4710UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-08-09T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Self-Funded / ErisaOrganizationORG4712BENICORP INSURANCE COMPANYBeneficiaryDenial Of ClaimNoNo Jurisdiction2012-08-20T00:00:002012-10-09T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company; Deceased Person757Ins Co - Licensed/ReceivershipOrganizationINDV4712HARTFORD LIFE AND ACCIDENT INSURANCE COMPANYBeneficiaryDenial Of ClaimNoInformation Furnished2012-08-20T00:00:002012-10-09T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company; Deceased Person2383Ins Co - Licensed/ActiveOrganizationINDV4713UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of Claim; Timely Filing Deficiency; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-20T00:00:002012-09-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Self-Funded / ErisaOrganizationORG4716UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling); Unsatisfactory Settle/OfferYesClaim Not Clean; Information Furnished; Additional Monies Received2012-08-09T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4719AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-08-09T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Self-Funded / ErisaOrganizationORGMULTIPLE INSUREDS4721AMERIGROUP TEXAS, INC.Third PartyDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-08-09T00:00:002012-10-17T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Person; Insured8032Health Maintenance OrgOrganizationORG4723CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-09T00:00:002013-01-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Self-Funded / ErisaOrganizationORG4725UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoInformation Furnished; Insufficient Information2012-08-09T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4734RBH Builders, LLCInsurance CompanyMisrepresentationNoInsufficient Information2012-08-27T00:00:002012-09-21T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company68423Claims AdjusterOrganizationORG4734Bitney, ClydeInsurance CompanyMisrepresentationNoInsufficient Information2012-08-27T00:00:002012-09-21T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company1146674OtherIndividualORG4738EXECUTIVE ROOFING COMPANYConsumer (Non-Insured)OtherNoInsufficient Information2012-08-27T00:00:002012-09-20T00:00:00Property and CasualtyHomeownersHomeowners68424OtherOrganizationORG4744UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)YesClaim Settled2012-08-10T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation4746ACCC INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished; Company Position Upheld2012-08-13T00:00:002012-10-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; REPLACEMENT VEHICLE; UNCOOPERATIVE INSURED; UNDERWRITING CRITERIA4749BANCROFT LIFE & CASUALTY ICCAttorneyNot Within TDI JurisdictionNoNo Jurisdiction2012-08-09T00:00:002012-10-23T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines68430OtherOrganizationORG4749ASSOCIATION BENEFITS GROUP, INCAttorneyUnauthorized ActsNoNo Jurisdiction2012-08-09T00:00:002012-10-23T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines73409OtherOrganizationORG4751BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-09T00:00:002012-11-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Self-Funded / ErisaOrganizationINDV4753NATIONWIDE MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld2012-08-30T00:00:002012-11-14T00:00:00Property and CasualtyMiscellaneousP & C Misc1937Ins Co - Licensed/ActiveOrganizationINDV4759AMERICAN RISK INSURANCE COMPANY, INC.InsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished2012-08-09T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeowners27377Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation4763TRAVELERS INDEMNITY COMPANY OF CONNECTICUT, THEProviderDelays (Claims Handling); Denial Of Claim; Unsatisfactory Settle/OfferNoOther; Information Furnished2012-08-27T00:00:002012-09-24T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Person; Correspondent Company; Insured1346WC Healthcare Provider NtwkOrganizationINDVGR-Claim Evaluation4764ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Company Position Upheld; Question of Fact2012-08-13T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency9825Ins Co - Licensed/ActiveOrganizationINDVCHIROPRACTIC; COVERAGE DISPUTE; GR-Claim Evaluation; LOSS OF USE; POLICY EXCLUSION; UNCOOPERATIVE INSURED4765UNITEDHEALTHCARE INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-08-29T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Self-Funded / ErisaOrganizationINDV4766CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-09T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Self-Funded / ErisaOrganizationORG4767GOVERNMENT EMPLOYEES INSURANCE COMPANYConsumer (Non-Insured)Cust Service Claim Handling; Unsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-08-13T00:00:002012-10-14T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation4769OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYLienholderDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Payment Expected; Information Furnished2012-08-09T00:00:002012-10-02T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured; Third Party Admin-Non Licensed1823Ins Co - Licensed/ActiveOrganizationORG4771WELLINGTON RISK INSURANCE AGENCY, INCInsuredDuplication of CoverageNoPremium Refunded; Information Furnished2012-08-13T00:00:002012-10-14T00:00:00Property and CasualtyHomeownersHomeowners4949Insurance AgencyOrganizationINDVUNDERWRITING CRITERIA4771GEICO INSURANCE AGENCY, INC.InsuredDuplication of CoverageNoPremium Refunded; Information Furnished2012-08-13T00:00:002012-10-14T00:00:00Property and CasualtyHomeownersHomeowners18534Insurance AgencyOrganizationINDVUNDERWRITING CRITERIA4774METROPOLITAN LIFE INSURANCE COMPANYBeneficiaryCash ValueNoRecord Only2012-08-30T00:00:002012-10-18T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person13191Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation4775AMERICAN AGENCY SYSTEM INSURANCE SERVICES LLCAgentAgency BalanceYesReferred for Disciplinary Actn2012-08-09T00:00:002012-11-28T00:00:00Property and CasualtyMiscellaneousP & C Misc23496Insurance AgencyOrganizationINDV4775STEIN, ROBERTAgentConversionYesReferred for Disciplinary Actn2012-08-09T00:00:002012-11-28T00:00:00Property and CasualtyMiscellaneousP & C Misc1144753AgentIndividualINDV4776AETNA LIFE INSURANCE COMPANYPhysicianDelays In AuthorizationNoNo Jurisdiction2012-08-09T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDV4780INFINITY COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoOther2012-08-09T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1197Ins Co - Licensed/ActiveOrganizationORG4784AMERICAN MEDICAL AND LIFE INSURANCE COMPANYInsuredAgent Handling; MisrepresentationNoInformation Furnished2012-08-10T00:00:002012-11-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Agency74Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE4784STRAHAN, GERALD LInsuredMisrepresentationYesFailure to Timely Respond2012-08-10T00:00:002012-11-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Agency964675AgentIndividualINDVCOVERAGE DISPUTE4786NATIONAL GENERAL INSURANCE COMPANYRelativeUnsatisfactory Settle/OfferYesAdditional Payment Expected2012-08-23T00:00:002012-09-07T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent1953Ins Co - Licensed/ActiveOrganizationINDV4792ALLSTATE TEXAS LLOYD'SRelativeUnsatisfactory Settle/OfferNoCompany Position Upheld; Appraisal Process Invoked; Information Furnished2012-08-29T00:00:002012-10-03T00:00:00Property and CasualtyHomeownersHomeownersInsured3721Ins Co - Licensed/ActiveOrganizationINDVAPPRAISAL; DAMAGE DISPUTE; GR-Claim Evaluation; ROOF4793TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYProviderDelays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-08-10T00:00:002012-10-14T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1450Ins Co - Licensed/ActiveOrganizationORGCHIROPRACTIC; GR-Claim Evaluation; UNCOOPERATIVE INSURED4795BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-08-27T00:00:002012-10-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Self-Funded / ErisaOrganizationINDVPRESCRIPTION4796BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling); Unsatisfactory Settle/OfferNoNo Jurisdiction; Contract Language/Legal Issue2012-08-09T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Self-Funded / ErisaOrganizationORG4797GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Additional Payment Expected; Question of Fact2012-08-12T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DIMINISHED VALUE; GR-Claim Evaluation4800AETNA LIFE INSURANCE COMPANYInsuredDelays In AuthorizationNoNo Jurisdiction2012-08-28T00:00:002012-10-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&HGR Elected Official; Insured245Self-Funded / ErisaOrganizationINDV4802MURPHY, CHRISTOPHER VERNONInsuredAgent Handling; Conversion; MisrepresentationYesFailure to Timely Respond; Referred for Disciplinary Actn2012-08-13T00:00:002013-01-08T00:00:00Property and CasualtyHomeownersHomeowners Group659500AgentIndividualINDV4804OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYProviderDenial Of ClaimNoCompany Position Upheld; Information Furnished; Contract Language/Legal Issue2012-08-08T00:00:002012-11-01T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationORGCHIROPRACTIC; GR-Claim Evaluation4805HUMANA HEALTH PLAN OF TEXAS, INC.ProviderDenial Of ClaimYesClean Claims Violation; Information Furnished; Additional Monies Received2012-08-09T00:00:002012-10-23T00:00:00Health Maintenance OrgAccident and HealthGroup A&HAssociated Subject Company; Insured702Health Maintenance OrgOrganizationORG4808BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-08-09T00:00:002012-10-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG4809UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoInformation Furnished2012-08-09T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4810AUTO CLUB INDEMNITY COMPANYInsuredPremium and RatingNoInformation Furnished; Company Position Upheld2012-08-13T00:00:002012-10-19T00:00:00Property and CasualtyHomeownersHomeowners8776Ins Co - Licensed/ActiveOrganizationINDVBILL OF RIGHTS - HO; UNDERWRITING CRITERIA4814UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoOther2012-08-09T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation4815AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling); Medical NecessityNoNo Jurisdiction2012-08-09T00:00:002012-11-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured245Ins Co - Licensed/ActiveOrganizationORG4818UNITED STATES FIRE INSURANCE COMPANYInsuredBalance Billing; Delays (Claims Handling); Delays (Underwriting); MisrepresentationNoContract Language/Legal Issue2012-08-10T00:00:002013-01-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company50626Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE4819BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderMedical NecessityNoNo Jurisdiction2012-08-09T00:00:002012-10-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG4822TEXAS FARMERS INSURANCE COMPANYInsuredLiability Dispute; Unsatisfactory Settle/OfferNoAppraisal Process Invoked; Information Furnished; Additional Monies Received2012-08-13T00:00:002012-10-23T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; DAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF4825UNITEDHEALTHCARE INSURANCE COMPANYProviderPrompt Pay; Unsatisfactory Settle/OfferYesClaim Not Clean; Additional Monies Received2012-08-09T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured1348Ins Co - Licensed/ActiveOrganizationORG4826BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of Claim; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-10T00:00:002012-12-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Self-Funded / ErisaOrganizationORGBUNDLING; GR-Claim Evaluation4829ESURANCE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoClaim Settled; Information Furnished; Company Position Upheld2012-08-13T00:00:002012-10-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass1350Ins Co - Licensed/ActiveOrganizationINDVACV; GR-Claim Evaluation; TOTAL LOSS4830DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received; Claim Settled; Information Furnished2012-08-13T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING4831FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-08-13T00:00:002012-10-13T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2623Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; CHIROPRACTIC; GR-Claim Evaluation4833AETNA LIFE INSURANCE COMPANYProviderDen/N-Pymt MD Nec DME/Supplies; Timely Filing DeficiencyNoNo Jurisdiction2012-08-10T00:00:002012-10-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation4834BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONPhysicianDenial Of Pymt For Emerg CareNoNo Jurisdiction2012-08-10T00:00:002012-10-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDVEMERGENCY CARE; GR-Claim Evaluation4836SAFECO INSURANCE COMPANY OF INDIANAOtherUnsatisfactory Settle/OfferNoInformation Furnished2012-08-11T00:00:002012-12-11T00:00:00Property and CasualtyHomeownersHomeownersInsured2496Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; OVERHEAD AND PROFIT; SUPPLEMENTARY PAYMENT4837AMERICAN HALLMARK INSURANCE COMPANY OF TEXASThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferYesInformation Furnished; Additional Payment Expected2012-08-10T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured699Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; LOSS OF USE4844SOUTHERN COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimYesAdditional Monies Received; Information Furnished2012-08-13T00:00:002012-12-28T00:00:00Property and CasualtyAutomobileMobile Owners1583Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation4845AAA TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and RatingYesInformation Furnished; Corrective Action Taken2012-08-13T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass2286Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN; UNDERWRITING CRITERIA4845KHAN FEROZ, HADI HUSSAINInsuredAgent HandlingNoInformation Furnished2012-08-13T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass898715AgentIndividualINDVSENIOR CITIZEN; UNDERWRITING CRITERIA4847HOMESITE LLOYD'S OF TEXASInsuredDelays (Claims Handling)YesClaim Settled; Additional Monies Received; Information Furnished2012-08-13T00:00:002012-10-12T00:00:00Property and CasualtyHomeownersHomeowners16072Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; WATER DAMAGE4849HALLMARK COUNTY MUTUAL INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling); Denial Of ClaimNoInformation Furnished; Company Position Upheld2012-08-13T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass1505Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; LOSS OF USE; TOTAL LOSS4850USAA TEXAS LLOYD'S COMPANYInsuredPremium and RatingNoCompany Position Upheld; Information Furnished2012-08-13T00:00:002012-10-13T00:00:00Property and CasualtyHomeownersHomeowners14630Ins Co - Licensed/ActiveOrganizationINDV4851HUMANA INSURANCE COMPANYInsuredCust Service Claim HandlingNoNo Jurisdiction2012-08-10T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationINDV4853HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling)NoInformation Furnished; Additional Monies Received; Claim Settled2012-08-13T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass2362Ins Co - Licensed/ActiveOrganizationINDVACV; ADJUSTER'S HANDLING; GR-Claim Evaluation; HAIL; LOSS OF USE; REPLACEMENT VEHICLE4854UNITEDHEALTHCARE INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Additional Monies Received2012-08-09T00:00:002012-10-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV4856OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received; Information Furnished; Company Position Upheld2012-08-13T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING4857AETNA LIFE INSURANCE COMPANYAttorneyDenial Of ClaimNoNo Jurisdiction2012-08-10T00:00:002012-11-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Self-Funded / ErisaOrganizationINDV4858AMERIGROUP INSURANCE COMPANYInsuredOtherNoInformation Furnished2012-08-10T00:00:002012-10-23T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H46957Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation4860OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled; Additional Monies Received2012-08-13T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING4862SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.InsuredDenial Of ClaimNoNo Jurisdiction2012-08-10T00:00:002012-10-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&H34661Self-Funded / ErisaOrganizationINDV4863COLONIAL COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Question of Fact2012-08-16T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass2455Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation4866HOME STATE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled; Additional Monies Received; Information Furnished2012-08-13T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured2362Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DIMINISHED VALUE4867COMPANION PROPERTY AND CASUALTY INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; Company Position Upheld2012-08-10T00:00:002012-11-06T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency10484Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation; WATER DAMAGE4867GUTIERREZ, JESUS ALBERTOInsuredAgent HandlingYesInformation Furnished2012-08-10T00:00:002012-11-06T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency842937AgentIndividualINDVCOVERAGE DISPUTE; GR-Claim Evaluation; WATER DAMAGE4873AMERIGROUP TEXAS, INC.HospitalDenial Of ClaimNoNo Jurisdiction2012-08-10T00:00:002012-11-20T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Person; Insured8032Health Maintenance OrgOrganizationORG4874OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-08-13T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVACV; ADJUSTER'S HANDLING; GR-Claim Evaluation; REPLACEMENT VEHICLE; TOTAL LOSS4875LOYA INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished; Company Position Upheld2012-08-10T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured15643Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation4877FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredCancellationNoInformation Furnished; Company Position Upheld2012-08-10T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA4879OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld; Information Furnished2012-08-10T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; POLICY EXCLUSION4880HOCHHEIM PRAIRIE FARM MUTUAL INSURANCE ASSOCIATIONInsuredDenial Of ClaimNoCompany Position Upheld2012-08-10T00:00:002012-10-11T00:00:00Property and CasualtyHomeownersHomeowners2350Ins Co - Licensed/ActiveOrganizationINDV4881UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling); Timely Filing DeficiencyYesAdditional Monies Received; Claim Not Clean2012-08-13T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation4882COLONIAL COUNTY MUTUAL INSURANCE COMPANYConsumer (Non-Insured)Denial Of ClaimNoAdditional Monies Received; Information Furnished2012-08-10T00:00:002012-10-02T00:00:00Property and CasualtyAutomobileIndividual Private Pass2455Ins Co - Licensed/ActiveOrganizationORGCOVERAGE DISPUTE4884TIME INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-08-10T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1374Ins Co - Licensed/ActiveOrganizationINDVGRANDFATHERED HEALTH PLAN; SENIOR CITIZEN4885ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredDelays (Claims Handling)NoAdditional Monies Received2012-08-10T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE4887STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDelays (Policyholder Service)NoInformation Furnished2012-08-30T00:00:002012-09-13T00:00:00Property and CasualtyAutomobileIndividual Private PassGR Elected Official1510Ins Co - Licensed/ActiveOrganizationINDV4888BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredPPACA-Preventive Health Svcs; Unsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-08-13T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE4889BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredAccess to CareNoNo Jurisdiction2012-08-13T00:00:002012-10-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; SUBSTANCE USE DISORDER4890UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesInformation Furnished; Corrective Action Taken2012-08-13T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation4892UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-13T00:00:002012-10-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4896AMERICAN HERITAGE LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-08-13T00:00:002012-10-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&H162Ins Co - Licensed/ActiveOrganizationINDV4898DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoCompany Position Upheld; Information Furnished2012-08-10T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2038Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; DEDUCTIBLE; UNCOOPERATIVE INSURED4899HUMANA INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferYesContract Language/Legal Issue; Information Furnished2012-08-13T00:00:002012-10-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationINDVPRESCRIPTION4900SUN LIFE ASSURANCE COMPANY OF CANADAInsuredDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-08-13T00:00:002012-10-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&H13240Self-Funded / ErisaOrganizationINDV4901CONTINENTAL LIFE INSURANCE COMPANY OF BRENTWOOD, TENNESSEEInsuredRefund Of PremiumNoAdditional Payment Expected2012-08-13T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H3707Ins Co - Licensed/ActiveOrganizationINDV4904HUMANA INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld2012-08-13T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation4905SOUTHERN COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoCompany Position Upheld2012-08-10T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1583Ins Co - Licensed/ActiveOrganizationINDV4906AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-10T00:00:002012-10-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG4907UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimYesAdditional Monies Received2012-08-10T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Person; Insured1348Ins Co - Licensed/ActiveOrganizationORG4908GEICO INDEMNITY COMPANYInsuredDelays (Claims Handling)NoClaim Settled2012-08-24T00:00:002012-08-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass2785Ins Co - Licensed/ActiveOrganizationINDVACV4909CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-10T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company2851Self-Funded / ErisaOrganizationORG4911FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoQuestion of Fact; Information Furnished2012-08-21T00:00:002012-09-20T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2623Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE4912AMERICAN BANKERS LIFE ASSURANCE COMPANY OF FLORIDARelativeDelays (Claims Handling)NoPolicy Not In Force2012-08-10T00:00:002012-11-24T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company; Deceased Person177Ins Co - Licensed/ActiveOrganizationINDV4914AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoInformation Furnished; No Jurisdiction2012-08-10T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured245Ins Co - Licensed/ActiveOrganizationORG4916AETNA HEALTH INC.Contracted ProviderUnsatisfactory Settle/OfferNoInformation Furnished2012-08-10T00:00:002012-10-31T00:00:00Health Maintenance OrgAccident and HealthGroup A&HAssociated Subject Person; Insured3522Health Maintenance OrgOrganizationORG4918HUMANA HEALTH PLAN OF TEXAS, INC.InsuredOtherNoNo Jurisdiction2012-08-10T00:00:002012-10-13T00:00:00Medicare HMOAccident and HealthIndividual A & H702Health Maintenance OrgOrganizationINDVSENIOR CITIZEN4919UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimYesClaim Settled2012-08-10T00:00:002012-10-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation4921BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferYesNo Jurisdiction; Contract Language/Legal Issue2012-08-10T00:00:002012-11-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORGGRANDFATHERED HEALTH PLAN4922BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of Claim; Medical NecessityNoQuestion of Fact; Insufficient Information2012-08-10T00:00:002012-10-22T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured10047Ins Co - Licensed/ActiveOrganizationORG4924TEXAS LIFE INSURANCE COMPANYAttorneyDelays (Claims Handling)NoInsufficient Information2012-08-27T00:00:002012-10-04T00:00:00Life, Accident and HealthLife & AnnuityGroup LifeAssociated Subject Person; Deceased Person1402Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation4925BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoContract Language/Legal Issue; Additional Monies Received2012-08-27T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured10047Ins Co - Licensed/ActiveOrganizationORG4926NATIONAL FARMERS UNION LIFE INSURANCE COMPANYInsuredCash ValueNoInformation Furnished; Contract Language/Legal Issue2012-08-10T00:00:002012-11-20T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company1945Ins Co - Licensed/ActiveOrganizationINDV4927LIBERTY MUTUAL INSURANCE COMPANYProviderDenial Of ClaimYesClaim Settled; Information Furnished2012-08-02T00:00:002012-09-27T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkCorrespondent Person; Insured Company2210Ins Co - Licensed/ActiveOrganizationORG4928BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONPhysicianDenial Of ClaimNoCorrective Action Taken; Other2012-08-10T00:00:002012-12-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationINDVEXPERIMENTAL/INVESTIGATIONAL4929UNITED HEALTHCARE OF TEXAS, INC.ProviderDelays (Claims Handling)NoAdditional Monies Received; Additional Payment Expected; Information Furnished2012-08-10T00:00:002012-10-17T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured68939Health Maintenance OrgOrganizationORGMULTIPLE INSUREDS4931L ESPERANCE, JASON MICHAELInsurance CompanyAgency BalanceYesInformation Furnished2012-07-27T00:00:002012-10-22T00:00:00Life, Accident and HealthMiscellaneousNo Line Specified988244AgentIndividualORG4932STATE FARM LIFE INSURANCE COMPANYInsuredOtherNoInformation Furnished2012-08-31T00:00:002012-10-22T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1509Ins Co - Licensed/ActiveOrganizationINDV4932PHYSICIANS LIFE INSURANCE COMPANYInsuredPremium NoticeNoInformation Furnished2012-08-31T00:00:002012-10-22T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1786Ins Co - Licensed/ActiveOrganizationINDV4932NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA.InsuredDenial Of ClaimNoInformation Furnished2012-08-31T00:00:002012-10-22T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1931Ins Co - Licensed/ActiveOrganizationINDV4933CONNECTICUT GENERAL LIFE INSURANCE COMPANYRelativeDenial Of ClaimNoNo Jurisdiction2012-08-13T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Self-Funded / ErisaOrganizationINDV4934BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling); SB418 Rule ViolationYesStat Pen Pd-Up To 45 Dys Late; Clean Claims Violation; Additional Monies Received2012-08-13T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORG4935HUMANA HEALTH PLAN OF TEXAS, INC.ProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-08-13T00:00:002012-11-03T00:00:00Health Maintenance OrgAccident and HealthGroup A&HAssociated Subject Company; Insured702Self-Funded / ErisaOrganizationORG4936BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoContract Language/Legal Issue; Company Position Upheld2012-08-14T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV4937AETNA LIFE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-13T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV4938OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld2012-08-09T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1823Ins Co - Licensed/ActiveOrganizationINDV4939BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-13T00:00:002012-10-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person10047Ins Co - Licensed/ActiveOrganizationINDV4940CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoRecord Only2012-08-13T00:00:002012-12-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured2851Ins Co - Licensed/ActiveOrganizationORG4941UMR, INC.ProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-13T00:00:002012-10-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured23490Third Party AdministratorsOrganizationORG4942BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld2012-08-30T00:00:002012-09-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company10047Ins Co - Licensed/ActiveOrganizationINDV4945ING LIFE INSURANCE AND ANNUITY COMPANYRelativeCancellationNoInformation Furnished; Policy Issued/Restored2012-08-13T00:00:002012-10-24T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company; Insured197Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN4945COZART, JOHN TIDWELLRelativeAgent HandlingNoInformation Furnished2012-08-13T00:00:002012-10-24T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company; Insured54408AgentIndividualINDVSENIOR CITIZEN4946HUMANA INSURANCE COMPANYAttorneyDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-08-13T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1040Ins Co - Licensed/ActiveOrganizationINDVPOLICY EXCLUSION; PRESCRIPTION4948TEXAS IMPERIAL LIFE INSURANCE COMPANYBeneficiaryCash ValueYesClaim Settled2012-08-13T00:00:002012-10-18T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeCorrespondent Person; Deceased Person998Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation4951CARGO INSURANCE CENTERAgentUnauthorized ActsYesOther2012-08-29T00:00:002012-11-16T00:00:00Property and CasualtyMiscellaneousP & C Misc73516Unauthorized ActivityOrganizationINDV4951PAF INSURANCEAgentUnauthorized ActsNoOther2012-08-29T00:00:002012-11-16T00:00:00Property and CasualtyMiscellaneousP & C Misc73517Unauthorized ActivityOrganizationINDV4951Greshman, DennisAgentUnauthorized ActsYesOther2012-08-29T00:00:002012-11-16T00:00:00Property and CasualtyMiscellaneousP & C Misc1154918Unauthorized ActivityIndividualINDV4952UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-12-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Self-Funded / ErisaOrganizationORG4953UNITEDHEALTHCARE INSURANCE COMPANYProviderTimely Filing Deficiency; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation4954UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4955UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4956FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoAdditional Payment Expected; Information Furnished2012-08-20T00:00:002012-09-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF4957UNITEDHEALTHCARE INSURANCE COMPANYProviderTimely Filing Deficiency; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation4958UNITEDHEALTHCARE INSURANCE COMPANYProviderTimely Filing Deficiency; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation4959UNITEDHEALTHCARE INSURANCE COMPANYProviderTimely Filing Deficiency; Unsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-08-14T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation4961UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-14T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Self-Funded / ErisaOrganizationORGGR-Claim Evaluation4963UNITEDHEALTHCARE INSURANCE COMPANYProviderTimely Filing Deficiency; Unsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-08-14T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation4964UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoOther2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Self-Funded / ErisaOrganizationORGGR-Claim Evaluation4965UNITEDHEALTHCARE INSURANCE COMPANYProviderTimely Filing Deficiency; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation4966UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-14T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation4967ATLANTIC CASUALTY INSURANCE COMPANYInsuredRefund Of PremiumNoContract Language/Legal Issue; Additional Monies Received2012-08-29T00:00:002012-12-07T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied LinesAssociated Subject Company; Insured Company52002Ins Co - Surplus LinesOrganizationINDVUNDERWRITING CRITERIA4967TOBOLKA, KEVIN WAYNEInsuredAgent Handling; MisrepresentationNoInformation Furnished2012-08-29T00:00:002012-12-07T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied LinesAssociated Subject Company; Insured Company609843AgentIndividualINDVUNDERWRITING CRITERIA4968UNITEDHEALTHCARE INSURANCE COMPANYProviderTimely Filing Deficiency; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation4970UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4971UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4972UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-10T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Self-Funded / ErisaOrganizationORG4973ALLSTATE INSURANCE COMPANYConsumer (Non-Insured)Claimant FraudNoInsufficient Information2012-08-10T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured168Ins Co - Licensed/ActiveOrganizationINDVMULTIPLE INSUREDS4974UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInsufficient Information2012-08-14T00:00:002013-02-08T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4975UNITEDHEALTHCARE INSURANCE COMPANYProviderTimely Filing Deficiency; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation4976UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesAdditional Monies Received; Corrective Action Taken2012-08-14T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4977BLUE CROSS AND BLUE SHIELD OF TEXAS, INC.InsuredDelays (Claims Handling)NoNo Jurisdiction2012-08-20T00:00:002012-10-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2402Self-Funded / ErisaOrganizationINDV4978OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-08-10T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company1823Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; NAMED DRIVER POLICY; UNDERWRITING CRITERIA4979UNITEDHEALTHCARE INSURANCE COMPANYProviderTimely Filing Deficiency; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Surplus LinesOrganizationORGGR-Claim Evaluation4980UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4981UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4982UNITEDHEALTHCARE INSURANCE COMPANYProviderTimely Filing Deficiency; Unsatisfactory Settle/OfferYesInformation Furnished; Corrective Action Taken2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation4983UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4984PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-08-10T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; CHIROPRACTIC; GR-Claim Evaluation4986UNITEDHEALTHCARE INSURANCE COMPANYProviderTimely Filing Deficiency; Unsatisfactory Settle/OfferNoNo Jurisdiction; Additional Monies Received2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation4987UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesInformation Furnished2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4988UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4990UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4991UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesInformation Furnished; Corrective Action Taken2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4992UNITEDHEALTHCARE INSURANCE COMPANYProviderTimely Filing Deficiency; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation4993UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4995UNITEDHEALTHCARE INSURANCE COMPANYProviderTimely Filing Deficiency; Unsatisfactory Settle/OfferYesInformation Furnished; Corrective Action Taken2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation4996UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG4998STATE FARM LLOYDSInsuredExcessive Rates; Premium and RatingNoContract Language/Legal Issue; Information Furnished2012-08-10T00:00:002012-10-15T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA4999UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG5000UNITEDHEALTHCARE INSURANCE COMPANYProviderTimely Filing Deficiency; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation5003UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG5004U S LLOYDS INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld; Information Furnished2012-08-10T00:00:002012-10-15T00:00:00Property and CasualtyHomeownersHomeowners3177Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation5005UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInsufficient Information2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG5006UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG5008UNITEDHEALTHCARE INSURANCE COMPANYProviderTimely Filing Deficiency; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation5009UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG5011UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG5013UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesCorrective Action Taken; Information Furnished2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG5014UNITEDHEALTHCARE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferYesInformation Furnished; Corrective Action Taken2012-08-14T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG5016LOYA INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Claim Settled; Additional Monies Received2012-08-10T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured15643Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED5017UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG5018UNITEDHEALTHCARE INSURANCE COMPANYProviderTimely Filing Deficiency; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Self-Funded / ErisaOrganizationORGGR-Claim Evaluation5021UNITEDHEALTHCARE INSURANCE COMPANYProviderTimely Filing Deficiency; Unsatisfactory Settle/OfferYesCorrective Action Taken; Information Furnished2012-08-14T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation5022UNITEDHEALTHCARE INSURANCE COMPANYInsuredTimely Filing Deficiency; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Self-Funded / ErisaOrganizationORGGR-Claim Evaluation5023UNITEDHEALTHCARE INSURANCE COMPANYProviderTimely Filing Deficiency; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Self-Funded / ErisaOrganizationORGGR-Claim Evaluation5024UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesInformation Furnished; Corrective Action Taken2012-08-14T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG5026UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Self-Funded / ErisaOrganizationORG5028CONNECTICUT GENERAL LIFE INSURANCE COMPANYInsuredPremium NoticeNoCancel/Non-Renewal Upheld2012-08-14T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2851Ins Co - Licensed/ActiveOrganizationINDVRESCISSION5029UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Self-Funded / ErisaOrganizationORG5030UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesInformation Furnished; Corrective Action Taken2012-08-14T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG5031UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Self-Funded / ErisaOrganizationORG5032UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Self-Funded / ErisaOrganizationORG5033UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesCorrective Action Taken; Information Furnished2012-08-14T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG5034SHA, L.L.C.ProviderDenial Of Claim; Timely Filing DeficiencyYesContract Language/Legal Issue2012-08-14T00:00:002012-12-14T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured7717Health Maintenance OrgOrganizationORGGR-Claim Evaluation5035UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Self-Funded / ErisaOrganizationORG5036HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredRefund Of PremiumNoInformation Furnished; Company Position Upheld2012-08-10T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency2362Ins Co - Licensed/ActiveOrganizationINDV5038GERMANIA FARM MUTUAL INSURANCE ASSOCIATIONInsuredUse of Credit ReportsNoInformation Furnished; Company Position Upheld2012-08-10T00:00:002012-11-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass2468Ins Co - Licensed/ActiveOrganizationINDVCREDIT REPORT5039REASSURE AMERICA LIFE INSURANCE COMPANYBeneficiaryOtherYesOther2012-08-14T00:00:002012-10-31T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person1228Ins Co - Licensed/ActiveOrganizationINDV5040UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Self-Funded / ErisaOrganizationORG5042PRUDENTIAL INSURANCE COMPANY OF AMERICA, THERelativeCash ValueNoInsufficient Information2012-08-14T00:00:002012-10-21T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured1729Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE5045UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesCorrective Action Taken; Information Furnished2012-08-14T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG5046UNITEDHEALTHCARE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferYesAdditional Monies Received2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDVEMERGENCY CARE5048CONNECTICUT GENERAL LIFE INSURANCE COMPANYRelativeDenial Of ClaimNoNo Jurisdiction2012-08-14T00:00:002012-10-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Self-Funded / ErisaOrganizationINDVGR-Claim Evaluation5049HUMANA INSURANCE COMPANYContracted ProviderDenial Of Claim; Medical NecessityNoInsufficient Information; Contract Language/Legal Issue2012-08-13T00:00:002012-10-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORG5051UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoCorrective Action Taken; Information Furnished; No Jurisdiction2012-08-14T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG5055UNION BANKERS INSURANCE COMPANYInsuredCash Value; Delays (Policyholder Service)NoInformation Furnished2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company1315Ins Co - Licensed/ActiveOrganizationINDV5056TEXAS HEALTH INSURANCE POOLInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company9031Ins Co - Licensed/ActiveOrganizationINDV5058BANKERS LIFE AND CASUALTY COMPANYInsuredRefund Of PremiumNoPremium Refunded; Contract Language/Legal Issue; Company Position Upheld2012-08-14T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H3030Ins Co - Licensed/ActiveOrganizationINDV5061HUMANA INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoAdditional Monies Received2012-08-14T00:00:002012-11-03T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1040Ins Co - Licensed/ActiveOrganizationORG5062COLONIAL COUNTY MUTUAL INSURANCE COMPANYInsuredCancellationYesClaim Settled2012-08-10T00:00:002012-10-13T00:00:00Property and CasualtyHomeownersHomeowners2455Ins Co - Licensed/ActiveOrganizationINDV5063TEXAS FARM BUREAU CASUALTY INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; Question of Fact; Information Furnished2012-08-29T00:00:002012-10-27T00:00:00Property and CasualtyHomeownersHomeowners28440Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA5066BANKERS LIFE AND CASUALTY COMPANYRelativeRefusal to Insure; Unfair DiscriminationNoInformation Furnished2012-08-14T00:00:002012-10-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured3030Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA5068STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoClaim Settled; Information Furnished; Question of Fact2012-08-10T00:00:002012-11-27T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; EMERGENCY CARE; GR-Claim Evaluation5069BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoInformation Furnished2012-08-31T00:00:002012-09-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationINDV5070BOON-CHAPMAN BENEFIT ADMINISTRATORS, INC.InsuredDenial Of ClaimNoNo Jurisdiction2012-08-14T00:00:002012-11-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured136371Self-Funded / ErisaOrganizationINDVGR-Claim Evaluation5074TEXAS HERITAGE INSURANCE COMPANYRelativePremium and RatingNoInformation Furnished2012-08-29T00:00:002012-10-17T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency; Insured25860Ins Co - Licensed/ActiveOrganizationINDV5076UNITEDHEALTHCARE INSURANCE COMPANYProviderRecoupment Of Claims PaymentNoContract Language/Legal Issue; Information Furnished2012-08-14T00:00:002012-10-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG5078UNITEDHEALTHCARE INSURANCE COMPANYProviderRecoupment Of Claims PaymentNoAdditional Monies Received; Information Furnished2012-08-14T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG5081HUMANA INSURANCE COMPANYProviderDenial Of Claim; Unsatisfactory Settle/OfferYesInformation Furnished; Corrective Action Taken2012-08-14T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person; Insured1040Ins Co - Licensed/ActiveOrganizationORG5082PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyLiability Dispute; Unsatisfactory Settle/OfferNoInformation Furnished2012-08-31T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDV5083UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)YesClaim Not Clean; Information Furnished; Additional Monies Received2012-08-14T00:00:002012-10-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured1348Ins Co - Licensed/ActiveOrganizationORG5084MURPHY, CHRISTOPHER VERNONInsuredConversionYesFailure to Timely Respond; Referred for Disciplinary Actn2012-08-13T00:00:002012-10-30T00:00:00Property and CasualtyHomeownersHomeowners GroupCorrespondent Company659500AgentIndividualINDV5087TEXAS GENERAL INSURANCE AGENCY LLCRelativeConversionYesNo Enforcement Case Opened; Referred for Disciplinary Actn2012-08-13T00:00:002013-02-08T00:00:00Property and CasualtyMiscellaneousP & C MiscInsured; Insured Company37001AgentOrganizationINDV5092Texas Country TitleConsumer (Non-Insured)Agent HandlingNoEarnest Money Paid Out2012-08-14T00:00:002012-11-19T00:00:00Property and CasualtyMiscellaneousTitle InsuranceThird Party Admin-Non Licensed73558AgentOrganizationINDV5093ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYConsumer (Non-Insured)Use of Credit ReportsNoInformation Furnished; Company Position Upheld2012-08-13T00:00:002012-11-02T00:00:00Property and CasualtyMiscellaneousNo Line Specified936Ins Co - Licensed/ActiveOrganizationINDV5095UNITEDHEALTHCARE OF TEXAS, INC.ProviderCoordination of Benefits; Delays (Claims Handling)YesInformation Furnished; Additional Monies Received; Additional Payment Expected2012-08-14T00:00:002012-11-02T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured3363Health Maintenance OrgOrganizationORGGR-Claim Evaluation5097AUTO CLUB INDEMNITY COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld2012-08-14T00:00:002012-10-12T00:00:00Property and CasualtyHomeownersRentalAssociated Agent; Insured8776Ins Co - Licensed/ActiveOrganizationINDV5098BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONContracted ProviderSB418 Rule Violation; Unsatisfactory Settle/OfferNoContract Language/Legal Issue2012-08-14T00:00:002012-11-03T00:00:00Health Maintenance OrgAccident and HealthIndividual A & HInsured10047Health Maintenance OrgOrganizationORGGR-Claim Evaluation5100TEXAS FARMERS INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-08-14T00:00:002012-10-16T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF5104RELIABLE LIFE INSURANCE COMPANY, THEInsuredCust Service Claim Handling; Delays (Policyholder Service)NoContract Language/Legal Issue2012-08-13T00:00:002012-11-03T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1704Ins Co - Licensed/ActiveOrganizationINDV5106SAN JACINTO TITLE SERVICES OF TEXAS, LLCAttorneyOtherNoCompany Position Upheld2012-08-14T00:00:002012-10-19T00:00:00Property and CasualtyMiscellaneousTitle Insurance73567AgentOrganizationINDV5110CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished2012-08-13T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationORG5111UNUM LIFE INSURANCE COMPANY OF AMERICAInsuredDelays (Claims Handling)NoInformation Furnished2012-08-13T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1327Ins Co - Licensed/ActiveOrganizationINDV5114CMFG LIFE INSURANCE COMPANYBeneficiaryDelays (Claims Handling)NoInformation Furnished; Additional Monies Received2012-08-13T00:00:002012-10-24T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person2734Ins Co - Licensed/ActiveOrganizationINDV5117FAMILY LIFE INSURANCE COMPANYInsuredRefund Of PremiumNoInformation Furnished; Premium Refunded2012-08-13T00:00:002012-11-05T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2657Ins Co - Licensed/ActiveOrganizationINDV5121RELIABLE LIFE INSURANCE COMPANY, THEInsuredCash Value; Delays (Policyholder Service)NoCash Surrender Paid2012-08-13T00:00:002012-10-21T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Agent1704Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5124UNITEDHEALTHCARE INSURANCE COMPANYInsuredDelays (Policyholder Service)NoNo Jurisdiction; Information Furnished2012-08-13T00:00:002012-10-22T00:00:00Medicare HMOAccident and HealthIndividual A & HAssociated Subject Person1348Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN5127SPJSTBeneficiaryUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-08-13T00:00:002012-11-13T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company; Deceased Person1566Ins Co - Licensed/ActiveOrganizationINDV5128HUMANA INSURANCE COMPANYInsuredNot Within TDI JurisdictionNoInformation Furnished; No Jurisdiction2012-08-13T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthHigh Deductible Hlth Ben Plan1040Ins Co - Licensed/ActiveOrganizationINDV5130NORTH AMERICAN COMPANY FOR LIFE AND HEALTH INSURANCEInsuredRefund Of PremiumNoInformation Furnished; Contract Language/Legal Issue2012-08-13T00:00:002012-10-29T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1899Ins Co - Licensed/ActiveOrganizationINDV5130GEORGE, THOMAS HOUSTONInsuredMisrepresentationNoInformation Furnished2012-08-13T00:00:002012-10-29T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life258232AgentIndividualINDV5133UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-13T00:00:002012-10-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured1348Ins Co - Licensed/ActiveOrganizationORG5136UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-08-13T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG5137AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoAdditional Monies Received; Information Furnished; No Jurisdiction2012-08-13T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured245Ins Co - Licensed/ActiveOrganizationORG5139PHILADELPHIA INDEMNITY INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Question of Fact2012-09-04T00:00:002012-12-11T00:00:00Property and CasualtyLiabilityGeneral LiabilityInsured Company3575Ins Co - Licensed/ActiveOrganizationINDV5142UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-13T00:00:002012-10-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV5145UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoAdditional Monies Received2012-08-13T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured1348Ins Co - Licensed/ActiveOrganizationINDV5148GROUP & PENSION ADMINISTRATORS, INC.ProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-13T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured32390Self-Funded / ErisaOrganizationORGGR-Claim Evaluation5149BANKERS LIFE AND CASUALTY COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Claim Settled; No Jurisdiction2012-08-13T00:00:002012-10-22T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H3030Ins Co - Licensed/ActiveOrganizationINDV5153MONUMENTAL LIFE INSURANCE COMPANYInsuredOtherNoInformation Furnished2012-08-13T00:00:002012-10-27T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company; Deceased Person2010Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5154UNITEDHEALTHCARE INSURANCE COMPANYInsuredDelays (Claims Handling)NoNo Jurisdiction2012-08-13T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Self-Funded / ErisaOrganizationINDV5156UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-13T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Self-Funded / ErisaOrganizationORG5158UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDenial Of ClaimNoNo Jurisdiction2012-08-13T00:00:002012-10-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured1348Ins Co - Licensed/ActiveOrganizationINDV5160AMERICAN GENERAL ASSURANCE COMPANYRelativeDelays (Claims Handling)NoClaim Settled; Additional Monies Received2012-08-13T00:00:002012-12-14T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person792Ins Co - Licensed/ActiveOrganizationINDV5161STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYAttorneyUnsatisfactory Settle/OfferNoClaim Settled2012-07-18T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5162AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished; Claim Settled2012-08-13T00:00:002012-10-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured245Ins Co - Licensed/ActiveOrganizationORG5164UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.ProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-13T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company; Insured14666Health Maintenance OrgOrganizationINDV5166STATE AUTO PROPERTY & CASUALTY INSURANCE COMPANYInsuredPremium and RatingYesClaim Settled2012-08-13T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured28439Ins Co - Licensed/ActiveOrganizationINDV5167UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-08-13T00:00:002012-10-11T00:00:00Medicare HMOAccident and HealthIndividual A & HInsured1348Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN5168OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Other; Company Position Upheld2012-08-13T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVACV; GR-Claim Evaluation; TOTAL LOSS5171STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYConsumer (Non-Insured)Refund Of PremiumNoInformation Furnished2012-08-14T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDV5171EARLEY, KATHRYN ELIZABETHConsumer (Non-Insured)Refund Of PremiumNoInformation Furnished2012-08-14T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured610161AgentIndividualINDV5175TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYInsuredDenial Of Claim; Unsatisfactory Settle/OfferNoInformation Furnished2012-08-14T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured1450Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE5175FLECK, KIMBERLY MCCULLOCHInsuredAgent HandlingNoQuestion of Fact2012-08-14T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured862971AgentIndividualINDVCOVERAGE DISPUTE5179UNITRIN COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished; Additional Payment Expected2012-08-14T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileBusiness AutomobileAssociated Agent1856Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE5180Ridge Roofing and ConstructionInsuredOtherNoInsufficient Information2012-08-28T00:00:002012-09-24T00:00:00Property and CasualtyMiscellaneousP & C Misc73610OtherOrganizationINDV5182TEXAS FARM BUREAU CASUALTY INSURANCE COMPANYInsuredRefund Of PremiumYesPremium Refunded; Information Furnished; Additional Monies Received2012-08-27T00:00:002012-11-08T00:00:00Property and CasualtyAutomobileIndividual Private Pass28440Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE5190COLONIAL COUNTY MUTUAL INSURANCE COMPANYConsumer (Non-Insured)Delays (Claims Handling)YesInformation Furnished; Claim Settled2012-08-16T00:00:002012-10-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass2455Ins Co - Licensed/ActiveOrganizationINDV5194TURPEN INSURANCE AGENCY INCConsumer (Non-Insured)Unauthorized ActsNoQuestion of Fact2012-08-14T00:00:002012-10-02T00:00:00Property and CasualtyMiscellaneousP & C MiscThird Party Admin-Non Licensed10363AgentOrganizationINDV5197STATE AUTO PROPERTY & CASUALTY INSURANCE COMPANYThird PartyDenial Of ClaimYesAdditional Monies Received; Information Furnished2012-08-14T00:00:002012-09-28T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured28439Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; LOSS OF USE; REPLACEMENT VEHICLE5200STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredUnauthorized ActsNoInformation Furnished2012-08-10T00:00:002012-10-02T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDV5200COOKE, DENNIS RAYInsuredMisrepresentationYesInformation Furnished2012-08-10T00:00:002012-10-02T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured59551AgentIndividualINDV5201ALLSTATE INSURANCE COMPANYConsumer (Non-Insured)Use of Credit ReportsNoInformation Furnished2012-08-10T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass168Ins Co - Licensed/ActiveOrganizationINDVCREDIT REPORT5201LAVERDE, LINDA MORENOConsumer (Non-Insured)Unauthorized ActsNoInformation Furnished2012-08-10T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass24018AgentIndividualINDVCREDIT REPORT5203ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-08-10T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; DRIVER NOT COVERED; POLICY EXCLUSION; UNDERWRITING CRITERIA5204HUMANA INSURANCE COMPANYNon-Contracted ProviderDenial Of Pymt For Emerg Care; Unsatisfactory Settle/OfferYesAdditional Monies Received; Information Furnished2012-08-14T00:00:002012-10-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person; Insured1040Ins Co - Licensed/ActiveOrganizationORGEMERGENCY CARE; GR-Claim Evaluation5206STARR SURPLUS LINES INSURANCE COMPANYInsuredDelays (Claims Handling); Non-RenewalYesAdditional Monies Received; Claim Settled; Information Furnished2012-08-10T00:00:002012-10-18T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied LinesAssociated Agent52716Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; HAIL; ROOF5207UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling); Timely Filing Deficiency; Unsatisfactory Settle/OfferNoAdditional Monies Received; Information Furnished2012-08-14T00:00:002012-10-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation5208NATIONAL FIRE INSURANCE COMPANY OF HARTFORDConsumer (Non-Insured)Delays (Claims Handling)YesAdditional Monies Received; Claim Settled2012-08-14T00:00:002012-10-13T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1949Ins Co - Licensed/ActiveOrganizationINDV5210INFINITY COUNTY MUTUAL INSURANCE COMPANYThird PartyLiability DisputeNoInformation Furnished; Company Position Upheld2012-08-14T00:00:002012-10-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass1197Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; DRIVER NOT COVERED; POLICY EXCLUSION5211Reunion TitleConsumer (Non-Insured)Agent HandlingNoInformation Furnished2012-08-14T00:00:002012-11-20T00:00:00Property and CasualtyMiscellaneousTitle Insurance66941AgentOrganizationINDV5215FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and RatingNoContract Language/Legal Issue; Information Furnished2012-08-14T00:00:002012-10-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA5216HERTZ CLAIM MANAGEMENTThird PartyDelays (Claims Handling)NoInformation Furnished; Additional Monies Received2012-08-14T00:00:002012-10-18T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent13349Third Party AdministratorsOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation5217GENERAL INSURANCE COMPANY OF AMERICAAttorneyUnsatisfactory Settle/OfferNoAdditional Monies Received; Company Position Upheld; Information Furnished2012-08-14T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured2508Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING5220LOYA INSURANCE COMPANYRelativeDelays (Claims Handling)YesInformation Furnished; Additional Monies Received2012-08-14T00:00:002012-10-18T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent15643Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING5221CONNECTICUT GENERAL LIFE INSURANCE COMPANYRelativeDelays (Claims Handling); Medical NecessityNoNo Jurisdiction2012-08-14T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Self-Funded / ErisaOrganizationINDVAUTISM SPECTRUM DISORDER; GR-Claim Evaluation5222AMERICA FIRST INSURANCE COMPANYAttorneyDelays (Claims Handling); Denial Of ClaimYesInformation Furnished; Claim Settled2012-08-14T00:00:002012-10-18T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent16071Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation5223AMERICAN GENERAL LIFE INSURANCE COMPANYInsuredCust Service Claim Handling; Refund Of PremiumNoInformation Furnished; Additional Monies Received2012-08-14T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H152Ins Co - Licensed/ActiveOrganizationINDV5224OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Additional Monies Received; Claim Settled2012-08-14T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Person1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING5225AETNA LIFE INSURANCE COMPANYInsuredCash Value; Denial Of ClaimNoNo Jurisdiction2012-08-14T00:00:002012-10-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5228HUMANA INSURANCE COMPANYProviderDenial Of ClaimNoContract Language/Legal Issue; Insufficient Information2012-08-14T00:00:002012-10-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation5231AETNA LIFE INSURANCE COMPANYInsuredCancellationNoNo Jurisdiction; Record Only2012-08-14T00:00:002012-10-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDVRESCISSION5232UNITEDHEALTHCARE INSURANCE COMPANYInsurance CompanyDenial Of ClaimNoAdditional Monies Received2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured1348Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation5235HUMANA INSURANCE COMPANYProviderDenial Of Claim; SB418 Rule Violation; Timely Filing DeficiencyNoNo Jurisdiction; Information Furnished2012-08-14T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured1040Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation5238CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoInsufficient Information2012-08-14T00:00:002012-12-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person2851Ins Co - Licensed/ActiveOrganizationORGCHIROPRACTIC; GR-Claim Evaluation5238AMERICAN SPECIALTY HEALTH NETWORKS, INC.ProviderDelays (Claims Handling); Timely Filing DeficiencyNoInsufficient Information2012-08-14T00:00:002012-12-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person103956Third Party AdministratorsOrganizationORGCHIROPRACTIC; GR-Claim Evaluation5239STATE FARM LLOYDSInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Claim Settled2012-08-27T00:00:002012-11-12T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE; HAIL5242AETNA LIFE INSURANCE COMPANYProviderCust Service Claim Handling; Delays (Claims Handling)NoNo Jurisdiction2012-08-15T00:00:002012-10-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationORG5245HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.ProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-15T00:00:002012-10-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&H27417Ins Co - Licensed/ActiveOrganizationORG5246SCOTT AND WHITE HEALTH PLANRelativeDenial Of Claim; Unsatisfactory Settle/OfferYesInformation Furnished; Additional Monies Received2012-08-15T00:00:002012-12-20T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured788Health Maintenance OrgOrganizationINDV5248CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANYProviderDenial Of Claim; SB418 Rule Violation; Timely Filing DeficiencyNoAdditional Monies Received2012-08-14T00:00:002012-10-01T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured25422Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation; SENIOR CITIZEN5249FIRST AMERICAN PROPERTY & CASUALTY INSURANCE COMPANYInsuredCust Service Claim Handling; Denial Of Claim; Refund Of PremiumNoInformation Furnished; Company Position Upheld2012-08-14T00:00:002012-10-12T00:00:00Property and CasualtyHomeownersRental25359Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF5250DAIRYLAND COUNTY MUTUAL INSURANCE COMPANY OF TEXASThird PartyDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-08-14T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileIndividual Private Pass2737Ins Co - Licensed/ActiveOrganizationINDVREPLACEMENT VEHICLE; TOTAL LOSS5251DRIVER'S INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)NoCompany Position Upheld; Information Furnished2012-08-14T00:00:002012-10-18T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Insured2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; UNCOOPERATIVE INSURED5252UNITED OF OMAHA LIFE INSURANCE COMPANYInsuredDenial Of Claim; Medical NecessityNoInformation Furnished; Additional Payment Expected2012-08-14T00:00:002012-10-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1281Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5254PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-08-14T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileTruckers PolicyAssociated Subject Agency; Associated Subject Company; Insured Company1708Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; BURDEN OF PROOF5256CENTURY SURETY COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received2012-08-14T00:00:002012-10-24T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied LinesAssociated Agent51851Ins Co - Surplus LinesOrganizationINDVAPPRAISAL5257TEXAS HEALTHSPRING, LLCInsuredNot Within TDI Jurisdiction; OtherNoInformation Furnished; No Jurisdiction2012-08-15T00:00:002012-10-17T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Person18634Ins Co - Licensed/ActiveOrganizationINDV5258PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling)NoAdditional Payment Expected; Information Furnished2012-08-14T00:00:002012-11-02T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent1708Ins Co - Licensed/ActiveOrganizationINDV5259ALLSTATE INDEMNITY COMPANYInsuredDelays (Claims Handling); Delays (Policyholder Service)NoAdditional Monies Received; Corrective Action Taken2012-08-14T00:00:002012-11-03T00:00:00Property and CasualtyAutomobileIndividual Private Pass167Ins Co - Licensed/ActiveOrganizationINDVTOTAL LOSS5261SOUTHWEST LIFE & HEALTH INSURANCE COMPANYProviderDenial Of Claim; SB418 Rule Violation; Timely Filing DeficiencyNoNo Jurisdiction2012-08-15T00:00:002012-10-10T00:00:00Health Maintenance OrgAccident and HealthIndividual A & HAssociated Subject Company; Insured2041Health Maintenance OrgOrganizationORGGR-Claim Evaluation5262HOMEOWNERS OF AMERICA INSURANCE COMPANYInsuredCancellation; Refund Of PremiumNoPremium Refunded2012-08-14T00:00:002012-11-23T00:00:00Property and CasualtyHomeownersHomeowners25247Ins Co - Licensed/ActiveOrganizationINDV5263CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDelays (Policyholder Service)NoNo Jurisdiction2012-08-15T00:00:002012-10-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Self-Funded / ErisaOrganizationORG5265AETNA LIFE INSURANCE COMPANYPhysicianOtherYesCorrective Action Taken; Information Furnished2012-08-15T00:00:002012-10-22T00:00:00Life, Accident and HealthMiscellaneousNo Line SpecifiedThird Party Admin-Non Licensed245Ins Co - Licensed/ActiveOrganizationINDV5266UNITEDHEALTHCARE INSURANCE COMPANYProviderAccess to Care; Delays In AuthorizationNoNo Jurisdiction2012-08-14T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation5270BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDelays (Policyholder Service)NoNo Jurisdiction2012-08-15T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationINDVPHARMACY5271OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYRelativeDelays (Claims Handling)YesAdditional Payment Expected2012-08-14T00:00:002012-11-23T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDV5272CONNECTICUT GENERAL LIFE INSURANCE COMPANYInsuredRefusal to InsureNoContract Language/Legal Issue2012-08-14T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2851Ins Co - Licensed/ActiveOrganizationINDV5281DEARBORN NATIONAL LIFE INSURANCE COMPANYBeneficiaryDelays (Policyholder Service)NoRecord Only; Referred To2012-08-15T00:00:002012-10-02T00:00:00Life, Accident and HealthLife & AnnuityGroup LifeDeceased Person1013Ins Co - Licensed/ActiveOrganizationINDV5285MCNA DENTALProviderDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-08-15T00:00:002012-10-25T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured66589Health Maintenance OrgOrganizationORGGR-Claim Evaluation5286PRUDENTIAL INSURANCE COMPANY OF AMERICA, THERelativeDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-08-16T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1729Ins Co - Licensed/ActiveOrganizationINDV5287UNITEDHEALTHCARE INSURANCE COMPANYInsuredBalance Billing; Denial Of Pymt For Emerg Care; Unsatisfactory Settle/OfferYesAdditional Monies Received2012-08-16T00:00:002012-10-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Associated Subject Person; Insured1348Ins Co - Licensed/ActiveOrganizationINDVEMERGENCY CARE; GR-Claim Evaluation5288BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDen/N-Pymt MD Nec RXNoNo Jurisdiction2012-08-16T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Self-Funded / ErisaOrganizationINDVPRESCRIPTION5289BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoContract Language/Legal Issue2012-08-16T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; PRESCRIPTION5290CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-08-16T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Self-Funded / ErisaOrganizationORG5292CERIDIAN BENEFITS SERVICES, INC.InsuredRefund Of PremiumNoNo Jurisdiction; Premium Refunded2012-08-16T00:00:002012-10-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&H47849Third Party AdministratorsOrganizationINDV5294TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYProviderAssignment of BenefitsYesClaim Settled; Additional Monies Received2012-08-16T00:00:002012-11-25T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1450Ins Co - Licensed/ActiveOrganizationORGCHIROPRACTIC; GR-Claim Evaluation5298Carnell, James Leonard IIIThird PartyMisrepresentationNoInformation Furnished2012-08-16T00:00:002012-12-10T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company; Associated Subject Person1146669OtherIndividualORG5299R.V.O.S. FARM MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Denial Of ClaimNoContract Language/Legal Issue; Question of Fact2012-08-13T00:00:002012-11-23T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent2621Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; ROOF; WATER DAMAGE5300STATE FARM LLOYDSInsuredUnsatisfactory Settle/OfferYesAdditional Monies Received2012-08-13T00:00:002012-11-17T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVOVERHEAD AND PROFIT; ROOF5300COOPER, BRENT PAULInsuredUnsatisfactory Settle/OfferNoInformation Furnished2012-08-13T00:00:002012-11-17T00:00:00Property and CasualtyHomeownersHomeowners46473AgentIndividualINDVOVERHEAD AND PROFIT; ROOF5301SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.Injured EmployeeAccess to CareYesCorrective Action Taken; Information Furnished2012-08-07T00:00:002012-10-29T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Company; Associated Subject Person54345WC Healthcare Provider NtwkOrganizationINDVADJUSTER'S HANDLING5303ALLSTATE INDEMNITY COMPANYThird PartyAssignment of Benefits; Unsatisfactory Settle/OfferNoClaim Settled; Additional Monies Received2012-08-14T00:00:002012-11-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent167Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING5309UNITEDHEALTHCARE OF TEXAS, INC.ProviderDelays (Claims Handling); SB418 Rule Violation; Timely Filing DeficiencyNoNo Jurisdiction2012-08-15T00:00:002012-11-29T00:00:00Health Maintenance OrgAccident and HealthIndividual A & HAssociated Subject Company; Insured3363Health Maintenance OrgOrganizationORGGR-Claim Evaluation5310STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; Question of Fact2012-08-14T00:00:002013-05-02T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; TOTAL LOSS5312UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling); SB418 Rule Violation; Timely Filing DeficiencyNoInformation Furnished2012-08-16T00:00:002012-10-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation5314AETNA LIFE INSURANCE COMPANYNon-Contracted ProviderDelays (Claims Handling); SB418 Rule Violation; Timely Filing DeficiencyNoInsufficient Information2012-08-16T00:00:002012-10-22T00:00:00Life, Accident and HealthMiscellaneousNo Line Specified245Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation5345STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXASThird PartyLiability DisputeYesQuestion of Fact2012-08-14T00:00:002012-11-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass1506Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF; COMPARATIVE NEGLIGENCE; GR-Claim Evaluation5347BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling); Timely Filing DeficiencyNoNo Jurisdiction2012-08-15T00:00:002012-10-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation5349OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferYesAdditional Monies Received2012-08-23T00:00:002012-11-27T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDV5350UNITEDHEALTHCARE INSURANCE COMPANYConsumer (Non-Insured)Den/N-Pymt MD Nec RXNoInformation Furnished2012-08-17T00:00:002012-10-10T00:00:00Utilization Review AgentAccident and HealthGroup A&HAssociated Subject Company; Insured1348Health Maintenance OrgOrganizationINDVPRESCRIPTION5351FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredAssignment of Benefits; Unsatisfactory Settle/OfferYesInformation Furnished; Referred for Disciplinary Actn2012-08-03T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Associated Subject Person2623Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation5352HUMANA HEALTH PLAN OF TEXAS, INC.Contracted ProviderDelays (Claims Handling); Unsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-08-16T00:00:002012-10-21T00:00:00Medicare HMOAccident and HealthIndividual A & HInsured702Health Maintenance OrgOrganizationINDVSENIOR CITIZEN5353ALTERRA AMERICA INSURANCE COMPANYAttorneyDelays (Claims Handling)NoAdditional Payment Expected; Company Position Upheld2012-08-13T00:00:002012-11-17T00:00:00Property and CasualtyLiabilityGeneral Liability2724Ins Co - Licensed/ActiveOrganizationINDV5354TEXAS FARMERS INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld2012-08-14T00:00:002012-11-24T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDV5357BAKER BENEFITS ADMINISTRATORS, INC.InsuredDelays (Policyholder Service)NoNo Jurisdiction; Information Furnished2012-08-16T00:00:002012-10-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&H52641Self-Funded / ErisaOrganizationINDVPRESCRIPTION5358VALUEOPTIONS OF TEXAS, INC.PhysicianDelays (Claims Handling)NoNo Jurisdiction; Information Furnished2012-09-07T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured8867Third Party AdministratorsOrganizationINDV5359MGA INSURANCE COMPANY, INC.AttorneyDenial Of ClaimNoInformation Furnished; Additional Payment Expected; Contract Language/Legal Issue2012-09-04T00:00:002012-11-02T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured812Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5360ALLSTATE INSURANCE COMPANYProviderDelays (Claims Handling)YesAdditional Monies Received2012-08-30T00:00:002012-10-01T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured168Ins Co - Licensed/ActiveOrganizationORG5361VALUEOPTIONS OF TEXAS, INC.PhysicianDelays (Claims Handling)NoReferred To; No Jurisdiction2012-09-07T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured8867Third Party AdministratorsOrganizationINDV5362BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredBalance Billing; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-16T00:00:002012-11-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Self-Funded / ErisaOrganizationINDVGR-Claim Evaluation5363COLUMBIA LLOYDS INSURANCE COMPANYInsuredDenial Of Claim; Unsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-08-13T00:00:002012-10-16T00:00:00Property and CasualtyHomeownersHomeowners3329Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; DAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF5365TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredDenial Of ClaimNoEntered Into Mediation2012-08-31T00:00:002012-12-06T00:00:00Property and CasualtyHomeownersHomeowners1444Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5366U S LLOYDS INSURANCE COMPANYInsuredCancellation; Refund Of PremiumNoPremium Refunded; Information Furnished2012-08-13T00:00:002012-10-18T00:00:00Property and CasualtyHomeownersHomeowners3177Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5367MEDWORK OF WISCONSIN, INC.ProviderType Of IRO Reviewer UsedNoInformation Furnished2012-08-15T00:00:002013-01-03T00:00:00Independent Review OrgAccident and HealthGroup A&HAssociated Subject Agency; Correspondent Person; Insured44203Independent Review Org (Iro)OrganizationORG5369OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDelays (Claims Handling)NoCompany Position Upheld; Question of Fact2012-08-14T00:00:002012-11-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company1823Ins Co - Licensed/ActiveOrganizationINDV5370Homesure of America IncInsuredRefund Of PremiumNoReferred To2012-08-15T00:00:002012-09-19T00:00:00Property and CasualtyMiscellaneousWarranty Contract73751OtherOrganizationINDV5371RAGSDALE, RONALD MATTHEWInsuredAgent HandlingYesReferred for Disciplinary Actn2012-08-13T00:00:002012-12-31T00:00:00Property and CasualtyAutomobileIndividual Private PassAlias Name; Associated Agent989033AgentIndividualINDV5372AMERICAN HOME SHIELDInsuredDelays (Claims Handling)NoReferred To2012-08-15T00:00:002012-09-19T00:00:00Property and CasualtyMiscellaneousWarranty Contract66787OtherOrganizationINDV5374ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling); Liability Dispute; Unsatisfactory Settle/OfferNoInformation Furnished; Complainant Retained Attorney; Additional Payment Expected2012-08-15T00:00:002012-11-20T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured9825Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation5375FIDELITY NATIONAL INDEMNITY INSURANCE COMPANYConsumer (Non-Insured)Non-RenewalNoCancel/Non-Renewal Upheld; Information Furnished2012-08-14T00:00:002012-11-30T00:00:00Property and CasualtyHomeownersHomeowners17723Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA5377UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of Claim; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-14T00:00:002012-10-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGBUNDLING; GR-Claim Evaluation5378INFINITY COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of Claim; Post-Claim UnderwritingNoContract Language/Legal Issue; Information Furnished2012-08-15T00:00:002012-10-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass1197Ins Co - Licensed/ActiveOrganizationINDV5379STANDARD LIFE AND ACCIDENT INSURANCE COMPANYRelativeRefund Of PremiumNoInformation Furnished; Contract Language/Legal Issue2012-08-14T00:00:002012-10-22T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1496Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE5382STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferYesAdditional Monies Received; Claim Settled2012-08-15T00:00:002012-11-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5383FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferYesComplainant Retained Attorney2012-08-15T00:00:002012-11-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVACV; DEPRECIATION5384STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-08-14T00:00:002012-10-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVTOTAL LOSS5386HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld2012-08-15T00:00:002012-11-25T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company2362Ins Co - Licensed/ActiveOrganizationINDV5387LEXINGTON INSURANCE COMPANYThird PartyLiability Dispute; Unsatisfactory Settle/OfferNoCompany Position Upheld2012-08-14T00:00:002012-12-12T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company48870Ins Co - Licensed/ActiveOrganizationINDVCOMPARATIVE NEGLIGENCE; GR-Claim Evaluation5388HPHG, LLCProviderDelays (Claims Handling); Timely Filing DeficiencyNoNo Jurisdiction2012-08-14T00:00:002012-10-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured35047Third Party AdministratorsOrganizationINDVGR-Claim Evaluation5390DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling)YesClaim Settled2012-08-14T00:00:002012-10-13T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; UNCOOPERATIVE INSURED5391UNITEDHEALTHCARE OF TEXAS, INC.BeneficiaryDenial Of ClaimNo2012-09-10T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Deceased Person; GR Elected Official3363Self-Funded / ErisaOrganizationINDV5391AETNA HEALTH INC.BeneficiaryDen/N-Pymt MD Nec Trmt N-EmrgNoNo Jurisdiction2012-09-10T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Deceased Person; GR Elected Official3522Health Maintenance OrgOrganizationINDV5391UNITED HEALTHCARE INSURANCE COMPANYBeneficiaryDenial Of ClaimNoNo Jurisdiction2012-09-10T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Deceased Person; GR Elected Official70310Self-Funded / ErisaOrganizationINDV5393FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoClaim Settled2012-08-15T00:00:002012-10-13T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2623Ins Co - Licensed/ActiveOrganizationORG5394ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling)NoQuestion of Fact; Additional Monies Received2012-08-15T00:00:002012-11-01T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured936Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DIMINISHED VALUE; GR-Claim Evaluation5396TEXAS FARMERS INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferYesInformation Furnished2012-08-15T00:00:002012-10-13T00:00:00Property and CasualtyHomeownersHomeownersInsured1452Ins Co - Licensed/ActiveOrganizationINDVHAIL; ROOF5397SAFECO LLOYDS INSURANCE COMPANYInsuredOtherYesInformation Furnished2012-08-14T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private Pass3223Ins Co - Licensed/ActiveOrganizationINDV5398DAIRYLAND COUNTY MUTUAL INSURANCE COMPANY OF TEXASConsumer (Non-Insured)Denial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-08-14T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2737Ins Co - Licensed/ActiveOrganizationINDV5399TRAVELERS LLOYDS OF TEXAS INSURANCE COMPANYInsuredCust Service Claim Handling; Denial Of ClaimNoCompany Position Upheld; Contract Language/Legal Issue2012-08-15T00:00:002012-11-25T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent776Ins Co - Licensed/ActiveOrganizationINDVFOUNDATION 5400COMPANION PROPERTY AND CASUALTY INSURANCE COMPANYInsuredDelays (Claims Handling)NoAdditional Payment Expected2012-08-14T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency10484Ins Co - Licensed/ActiveOrganizationINDV5401AUTO CLUB INDEMNITY COMPANYInsuredPremium Notice; Refund Of PremiumNoCompany Position Upheld; Question of Fact2012-08-15T00:00:002012-11-17T00:00:00Property and CasualtyHomeownersHomeowners8776Ins Co - Licensed/ActiveOrganizationINDV5402PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYConsumer (Non-Insured)Delays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received2012-08-14T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileBusiness Automobile1708Ins Co - Licensed/ActiveOrganizationINDVLOSS OF USE; REPLACEMENT VEHICLE5403LIBERTY COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled; Additional Monies Received2012-08-15T00:00:002012-11-14T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured3762Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING5404AMERICAN RISK INSURANCE COMPANY, INC.InsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoComplainant Retained Attorney2012-08-15T00:00:002012-10-25T00:00:00Property and CasualtyHomeownersHomeowners27377Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; HAIL; ROOF5405DAIRYLAND COUNTY MUTUAL INSURANCE COMPANY OF TEXASInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferYesClaim Settled; Additional Monies Received2012-08-15T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent2737Ins Co - Licensed/ActiveOrganizationINDVCOMPARATIVE NEGLIGENCE; GR-Claim Evaluation; REPLACEMENT VEHICLE5406METROPOLITAN LLOYDS INSURANCE COMPANY OF TEXASInsuredIncreased Dwelling Coverage; Refund Of PremiumNoInformation Furnished2012-08-15T00:00:002012-10-19T00:00:00Property and CasualtyHomeownersHomeowners3848Ins Co - Licensed/ActiveOrganizationINDV5407PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-08-15T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDV5408CONSUMERS COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; Question of Fact; Information Furnished2012-08-15T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass2806Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5412BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredMedical Necessity; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-09-04T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Correspondent Company10047Self-Funded / ErisaOrganizationINDVGR-Claim Evaluation5416SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.RelativeRefund Of PremiumNoInformation Furnished; Company Position Upheld2012-09-06T00:00:002012-11-12T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HDeceased Person1203Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE5417UNITED AMERICAN INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-08-16T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&H801Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5418PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferYesInformation Furnished; Claim Settled2012-08-15T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVTOTAL LOSS5420BENEFIT MANAGEMENT ADMINISTRATORS, INC.ProviderDelays (Claims Handling); Timely Filing DeficiencyNoNo Jurisdiction; Additional Payment Expected2012-08-16T00:00:002012-12-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured56902Self-Funded / ErisaOrganizationORGGR-Claim Evaluation5421CORVEL HEALTHCARE CORPORATIONNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-08-14T00:00:002012-11-05T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Company; Injured Employee54533WC Healthcare Provider NtwkOrganizationORGGR-Claim Evaluation5422GERMANIA SELECT INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished2012-08-15T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass17678Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF; DAMAGE DISPUTE5425ALAMO TITLE INSURANCEInsuredEndorsement / RiderNoInformation Furnished2012-08-16T00:00:002012-10-03T00:00:00Property and CasualtyMiscellaneousTitle InsuranceAssociated Subject Company51821Ins Co - Licensed/ActiveOrganizationINDV5426UNITEDHEALTHCARE INSURANCE COMPANYProviderDen/N-Pymt MD Nec Trmt N-Emrg; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-16T00:00:002012-10-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation5427MURPHY, CHRISTOPHER VERNONInsuredConversionYesReferred for Disciplinary Actn; Failure to Timely Respond2012-08-16T00:00:002012-10-24T00:00:00Property and CasualtyHomeownersHomeowners GroupAssociated Subject Agency659500AgentIndividualINDV5428ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Question of Fact2012-08-16T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5431UNITED SERVICES AUTOMOBILE ASSOCIATIONInsuredUnsatisfactory Settle/OfferNoQuestion of Fact; Contract Language/Legal Issue2012-08-16T00:00:002012-11-27T00:00:00Property and CasualtyHomeownersHomeowners1254Ins Co - Licensed/ActiveOrganizationINDVHAIL; ROOF; WATER DAMAGE5433ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Additional Monies Received2012-08-16T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDV5433STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyOtherNoInformation Furnished; Additional Monies Received2012-08-16T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV5433FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished2012-08-16T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDV5435BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDelays (Claims Handling); Denial Of ClaimNoNo Jurisdiction2012-08-14T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company10047Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5436OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of ClaimNoQuestion of Fact; Information Furnished2012-08-16T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company1823Ins Co - Licensed/ActiveOrganizationORGBURDEN OF PROOF5437DRIVER'S INSURANCE COMPANYInsuredCancellationYesPremium Refunded; Information Furnished2012-08-16T00:00:002012-11-12T00:00:00Property and CasualtyAutomobileIndividual Private PassCorrespondent Person2038Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA5437SHANZE ENTERPRISES INC.InsuredConversionYesInformation Furnished2012-08-16T00:00:002012-11-12T00:00:00Property and CasualtyAutomobileIndividual Private PassCorrespondent Person25945Insurance AgencyOrganizationINDVUNDERWRITING CRITERIA5440UNITEDHEALTHCARE OF TEXAS, INC.ProviderDen/N-Pymt MD Nec Trmt N-Emrg; Unsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-08-15T00:00:002012-10-21T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured3363Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation5441TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredRefund Of PremiumNoPremium Refunded; Information Furnished2012-08-15T00:00:002012-10-17T00:00:00Property and CasualtyHomeownersHomeowners Group1444TWIAOrganizationINDV5442LIBERTY COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Liability Dispute; Unsatisfactory Settle/OfferNoClaim Settled; Information Furnished2012-08-16T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass3762Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF5443UNITED OF OMAHA LIFE INSURANCE COMPANYInsuredOther; Refund Of PremiumYesPremium Refunded2012-08-14T00:00:002012-10-12T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1281Ins Co - Licensed/ActiveOrganizationINDV5444GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredDelays (Policyholder Service)NoCancellation Withdrawn; Additional Monies Received; Information Furnished2012-08-16T00:00:002012-12-06T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDV5447NATIONWIDE LIFE INSURANCE COMPANYInsuredDelays (Claims Handling)YesClaim Settled2012-08-15T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HThird Party Admin-Licensed1935Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE5448MERITPLAN INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling)NoClaim Settled; Additional Monies Received; Information Furnished2012-08-15T00:00:002012-11-14T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency; Associated Subject Person727Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING5449USAA GENERAL INDEMNITY COMPANYInsuredLiability DisputeNoContract Language/Legal Issue; Question of Fact; Information Furnished2012-08-15T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured1276Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF5450SAFECO INSURANCE COMPANY OF INDIANAInsuredIncreased Dwelling Coverage; Premium NoticeYesRate Problem Resolved2012-08-15T00:00:002012-10-17T00:00:00Property and CasualtyHomeownersHomeowners2496Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA5450BOENKER, ALVIN HENRY IIIInsuredAgent HandlingNoInformation Furnished2012-08-15T00:00:002012-10-17T00:00:00Property and CasualtyHomeownersHomeowners115268AgentIndividualINDVUNDERWRITING CRITERIA5453STATE FARM LIFE INSURANCE COMPANYInsuredCash ValueNoInformation Furnished2012-08-16T00:00:002012-11-01T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeCorrespondent Company1509Ins Co - Licensed/ActiveOrganizationINDV5455GROUP & PENSION ADMINISTRATORS, INC.ProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-16T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H32390Self-Funded / ErisaOrganizationORGGR-Claim Evaluation5456AMICA MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoContract Language/Legal Issue2012-08-15T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass3532Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation5457AFFINION BENEFITS GROUP, LLCInsuredMisrepresentation; Refund Of PremiumNoContract Language/Legal Issue; Information Furnished2012-08-20T00:00:002012-12-06T00:00:00Property and CasualtyMiscellaneousP & C Misc29114Third Party AdministratorsOrganizationINDVCOVERAGE DISPUTE5460GEICO INDEMNITY COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferYesAdditional Monies Received; Information Furnished; Corrective Action Taken2012-08-16T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private Pass2785Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; UNDERWRITING CRITERIA5461FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYAttorneyDelays (Claims Handling)NoInformation Furnished; Additional Payment Expected; Company Position Upheld2012-08-15T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2623Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; CHIROPRACTIC5462AETNA LIFE INSURANCE COMPANYContracted ProviderPrompt Pay; Unsatisfactory Settle/OfferNoInformation Furnished2012-08-16T00:00:002012-12-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ReceivershipOrganizationORGGR-Claim Evaluation5464LSI Title Agency IncConsumer (Non-Insured)Agent HandlingYesInformation Furnished2012-08-15T00:00:002012-12-27T00:00:00Property and CasualtyMiscellaneousTitle InsuranceThird Party Admin-Non Licensed73805AgentOrganizationINDV5468CONTINENTAL AIRLINESRelativeDelays (Policyholder Service)NoInsufficient Information2012-08-16T00:00:002012-12-11T00:00:00Life, Accident and HealthLife & AnnuityGroup LifeDeceased Person21152OtherOrganizationINDVCOVERAGE DISPUTE5469HOME STATE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Liability DisputeNoCompany Position Upheld; Information Furnished; Question of Fact2012-08-16T00:00:002012-11-16T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Associated Subject Agency; Insured2362Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; SENIOR CITIZEN5470ACCC INSURANCE COMPANYInsuredBalance Billing; Refund Of PremiumYesInformation Furnished; Premium Refunded2012-08-16T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA5474HUMANA INSURANCE COMPANYProviderDenial Of Claim; Timely Filing DeficiencyNoAdditional Monies Received; No Jurisdiction2012-08-16T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN5475HUMANA INSURANCE COMPANYProviderDenial Of Claim; Timely Filing DeficiencyNoNo Jurisdiction; Information Furnished2012-08-16T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation5476UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-16T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Self-Funded / ErisaOrganizationORGGR-Claim Evaluation5477USAA GENERAL INDEMNITY COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling)NoAdditional Monies Received; Information Furnished; Additional Payment Expected2012-08-16T00:00:002014-01-09T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent1276Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation5478HEALTH REINSURANCE MANAGEMENT PARTNERSHIP/CONVERSION OFFICEInsuredDelays (Claims Handling)NoOther2012-08-30T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&H56136Ins Co - Licensed/ActiveOrganizationINDV5479CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-16T00:00:002012-09-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured25422Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN5480AETNA LIFE INSURANCE COMPANYInsuredDelays (Claims Handling)NoOther2012-09-10T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV5481UNIVERSAL NORTH AMERICA INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling)YesClaim Settled; Additional Payment Expected2012-08-16T00:00:002012-10-09T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent23526Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING5484PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)YesInformation Furnished; Additional Monies Received2012-08-16T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent1708Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation5485UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling); Timely Filing DeficiencyNoInformation Furnished; No Jurisdiction2012-08-16T00:00:002012-10-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Self-Funded / ErisaOrganizationORGGR-Claim Evaluation5487GRI OF HOUSTON, LLCProviderDelays (Claims Handling); Timely Filing DeficiencyNoInformation Furnished; No Jurisdiction2012-08-16T00:00:002012-10-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured47622Self-Funded / ErisaOrganizationORGGR-Claim Evaluation5489TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoComplainant Retained Attorney; Information Furnished2012-08-16T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured1450Ins Co - Licensed/ActiveOrganizationINDVACV; ADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation; TOTAL LOSS5491GERMANIA FARM MUTUAL INSURANCE ASSOCIATIONInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-08-16T00:00:002012-10-19T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent2468Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; OVERHEAD AND PROFIT; UNDERWRITING CRITERIA5492MONUMENTAL LIFE INSURANCE COMPANYInsuredOtherNoInformation Furnished2012-08-16T00:00:002013-01-09T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company2010Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE5498CHURCH MUTUAL INSURANCE COMPANYInsuredNon-RenewalNoInformation Furnished; Company Position Upheld2012-08-15T00:00:002012-10-19T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines3210Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; HAIL; ROOF; UNDERWRITING CRITERIA5499TEXAS FARMERS INSURANCE COMPANYConsumer (Non-Insured)Denial Of ClaimNoQuestion of Fact; Information Furnished; Complainant Retained Attorney2012-08-16T00:00:002012-10-11T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation5502BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of Pymt For Emerg Care; Unsatisfactory Settle/OfferYesClaim Settled; Additional Monies Received2012-08-14T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company; Insured10047Ins Co - Licensed/ActiveOrganizationORGEMERGENCY CARE; GR-Claim Evaluation5503TRAVELERS LLOYDS OF TEXAS INSURANCE COMPANYInsuredCancellationNoContract Language/Legal Issue; Information Furnished2012-08-14T00:00:002013-01-22T00:00:00Property and CasualtyHomeownersHomeowners776Ins Co - Licensed/ActiveOrganizationINDV5505COLONIAL COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Underwriting)YesInformation Furnished2012-08-16T00:00:002012-10-09T00:00:00Property and CasualtyAutomobileIndividual Private Pass2455Ins Co - Licensed/ActiveOrganizationINDV5506BANNER LIFE INSURANCE COMPANYInsuredDelays (Underwriting)NoInformation Furnished2012-08-17T00:00:002012-11-30T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeCorrespondent Person657Ins Co - Licensed/ActiveOrganizationINDV5507HOME STATE COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoQuestion of Fact; Information Furnished2012-08-14T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Insured2362Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF5508AIM BENEFIT SERVICES, INC.Injured EmployeeDelays (Claims Handling)YesContract Language/Legal Issue2012-09-04T00:00:002013-04-23T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company51262OtherOrganizationINDVGR-Claim Evaluation5510FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Delays (Policyholder Service)YesCorrective Action Taken2012-08-16T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA5510COX, DAVID CURTISInsuredAgent Handling; Delays (Policyholder Service)NoInformation Furnished2012-08-16T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass110714AgentIndividualINDVUNDERWRITING CRITERIA5513FIDELITY SECURITY LIFE INSURANCE COMPANYInsuredDelays (Claims Handling)YesContract Language/Legal Issue2012-08-17T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2592Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5514TEXAS MUTUAL INSURANCE COMPANYContracted ProviderUnsatisfactory Settle/OfferYesInformation Furnished2012-08-21T00:00:002013-04-18T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Company; Injured Employee3500Ins Co - Licensed/ActiveOrganizationORG5515FORTE, INC. / COMPKEY PLUSInjured EmployeeOther; OtherNoInformation Furnished2012-09-04T00:00:002013-09-12T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Company53636WC Healthcare Provider NtwkOrganizationINDV5516BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of Claim; Medical NecessityNoContract Language/Legal Issue2012-08-17T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation5517UNDERWRITERS AT LLOYD'S, LONDONThird PartyCust Service Claim HandlingNoContract Language/Legal Issue; Information Furnished2012-08-16T00:00:002012-10-11T00:00:00Property and CasualtyMiscellaneousSurplus LinesAssociated Subject Agency; Insured55949Ins Co - Surplus LinesOrganizationINDVADJUSTER'S HANDLING5518AETNA LIFE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-17T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5519STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferYesClaim Settled; Additional Monies Received2012-08-16T00:00:002012-11-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVAFTERMARKET PARTS; GR-Claim Evaluation5520FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)YesCorrective Action Taken; Additional Payment Expected; Information Furnished2012-08-16T00:00:002012-11-07T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Associated Subject Person; Insured2623Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING5522STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeNoComplainant Retained Attorney; Question of Fact2012-08-16T00:00:002012-11-26T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COMPARATIVE NEGLIGENCE; TOTAL LOSS5524CELEBRITY TITLE COMPANY, LLCInsuredUnrecorded DocumentsNoInformation Furnished2012-08-16T00:00:002012-10-12T00:00:00Property and CasualtyMiscellaneousTitle Insurance73818AgentOrganizationINDV5525ACCC INSURANCE COMPANYInsuredDelays (Claims Handling)NoClaim Settled2012-08-16T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency9825Ins Co - Licensed/ActiveOrganizationINDVREPLACEMENT VEHICLE; TOTAL LOSS5528HELMSMAN MANAGEMENT SERVICES, INC.Injured EmployeeMedical NecessityNoClaim Settled2012-08-16T00:00:002012-10-23T00:00:00Life, Accident and HealthMiscellaneousWorkers' Compensation NtwkInsured Company48700Third Party AdministratorsOrganizationINDVGR-Claim Evaluation5529METROPOLITAN LLOYDS INSURANCE COMPANY OF TEXASInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished; Question of Fact2012-08-16T00:00:002012-10-16T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent3848Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE5534UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.Contracted ProviderOtherNoInformation Furnished; No Jurisdiction2012-08-17T00:00:002012-10-30T00:00:00Health Maintenance OrgAccident and HealthGroup A&H14666Health Maintenance OrgOrganizationORG5535LIBERTY INSURANCE CORPORATIONInsuredDelays (Underwriting); Denial Of ClaimYesCorrective Action Taken; Information Furnished; Additional Monies Received2012-08-16T00:00:002012-10-16T00:00:00Property and CasualtyHomeownersHomeowners3636Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; UNDERWRITING CRITERIA5539TRAVELERS LLOYDS INSURANCE COMPANY, THEInsuredDelays (Claims Handling)NoAdditional Monies Received; Contract Language/Legal Issue2012-08-16T00:00:002012-10-09T00:00:00Property and CasualtyHomeownersHomeowners777Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; DAMAGE DISPUTE; HAIL; ROOF5540SUPERIOR HEALTHPLAN, INC.Contracted ProviderDenial Of ClaimNoInformation Furnished; No Jurisdiction2012-08-16T00:00:002012-11-02T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured10198Health Maintenance OrgOrganizationORGGR-Claim Evaluation5543FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYProviderAssignment of Benefits; Delays (Claims Handling)NoContract Language/Legal Issue; Information Furnished2012-08-16T00:00:002012-11-20T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Correspondent Person; Insured2623Ins Co - Licensed/ActiveOrganizationORGUNCOOPERATIVE INSURED5546FOREMOST LLOYDS OF TEXASInsuredDenial Of ClaimNoCompany Position Upheld2012-08-16T00:00:002012-10-17T00:00:00Property and CasualtyHomeownersHomeowners698Ins Co - Licensed/ActiveOrganizationINDV5549TITLE RESOURCES GUARANTY COMPANYLienholderDelays (Claims Handling)NoCompany Position Upheld2012-09-04T00:00:002012-10-24T00:00:00Property and CasualtyMiscellaneousTitle InsuranceAssociated Agent56680Ins Co - Licensed/ActiveOrganizationINDV5555SAFE AUTO INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished2012-08-16T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private Pass25980Ins Co - Licensed/ActiveOrganizationINDV5556HEALTH NET LIFE INSURANCE COMPANYBeneficiaryOtherNoInsufficient Information2012-08-16T00:00:002012-12-11T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2049Ins Co - Licensed/ActiveOrganizationINDV5557HOME STATE COUNTY MUTUAL INSURANCE COMPANYProviderDenial Of ClaimNoInformation Furnished2012-08-16T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2362Ins Co - Licensed/ActiveOrganizationORG5560BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredPre-Existing Condition; Recoupment Of Claims PaymentNoInsufficient Information; Contract Language/Legal Issue2012-09-11T00:00:002012-10-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation5561METROPOLITAN LIFE INSURANCE COMPANYBeneficiaryCash ValueNoInformation Furnished2012-08-17T00:00:002012-10-25T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured13191Ins Co - Licensed/ActiveOrganizationINDV5562DRIVER'S INSURANCE COMPANYAgentCommissionsNoNo Jurisdiction2012-08-16T00:00:002012-10-23T00:00:00Property and CasualtyMiscellaneousP & C Misc2038Ins Co - Licensed/ActiveOrganizationORG5562LINDSAY GENERAL INSURANCE AGENCY LLCAgentCommissionsNoNo Jurisdiction2012-08-16T00:00:002012-10-23T00:00:00Property and CasualtyMiscellaneousP & C Misc22343Insurance AgencyOrganizationORG5563BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoAdditional Monies Received; No Jurisdiction; Information Furnished2012-08-17T00:00:002012-10-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation5565ASI LLOYDSInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Additional Payment Expected2012-08-16T00:00:002012-10-17T00:00:00Property and CasualtyHomeownersHomeowners14728Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE5569PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYAttorneyDelays (Claims Handling)NoAdditional Payment Expected; Information Furnished2012-08-16T00:00:002012-10-10T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent1708Ins Co - Licensed/ActiveOrganizationORG5571GROUP & PENSION ADMINISTRATORS, INC.InsuredNot Within TDI JurisdictionNoNo Jurisdiction2012-08-17T00:00:002012-11-20T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company32390Self-Funded / ErisaOrganizationINDVCOVERAGE DISPUTE5573OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredPremium NoticeNoInformation Furnished2012-08-16T00:00:002012-10-10T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDV5577CATLIN SPECIALTY INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-08-16T00:00:002012-10-09T00:00:00Property and CasualtyLiabilityGeneral Liability48388Ins Co - Surplus LinesOrganizationINDV5577DRAGER, PAUL JOSEPHInsuredDenial Of ClaimNoInformation Furnished2012-08-16T00:00:002012-10-09T00:00:00Property and CasualtyLiabilityGeneral Liability83399AgentIndividualINDV5581ZURICH AMERICAN INSURANCE COMPANYInjured EmployeeDenial Of ClaimNoContract Language/Legal Issue; Additional Payment Expected2012-08-10T00:00:002012-12-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10087Ins Co - Licensed/ActiveOrganizationINDV5584TRINITY UNIVERSAL INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished2012-08-16T00:00:002013-02-28T00:00:00Property and CasualtyAutomobileIndividual Private Pass1353Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF; COVERAGE DISPUTE5584COOPER, DENNIS VICTORInsuredAgent HandlingYesAdditional Payment Expected; Information Furnished2012-08-16T00:00:002013-02-28T00:00:00Property and CasualtyAutomobileIndividual Private Pass111468AgentIndividualINDVADJUSTER'S HANDLING; BURDEN OF PROOF; COVERAGE DISPUTE5585CIGNA HEALTHCARE OF TEXAS, INC.InsuredAccess to CareNoNo Jurisdiction2012-09-10T00:00:002012-10-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Deceased Person8294Health Maintenance OrgOrganizationINDVCANCER5586TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoComplainant Retained Attorney; Additional Monies Received2012-08-17T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent1450Ins Co - Licensed/ActiveOrganizationINDV5587AETNA LIFE INSURANCE COMPANYInsuredAccess to Care; Delays (Policyholder Service); Delays In AuthorizationYesInformation Furnished2012-08-17T00:00:002013-03-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDVCANCER5588PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimYesClaim Settled; Additional Monies Received2012-08-17T00:00:002012-12-04T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1708Ins Co - Licensed/ActiveOrganizationINDV5589TEXAS FARMERS INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld2012-08-17T00:00:002012-10-17T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDV5590BRISTOL WEST SPECIALTY INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld2012-08-16T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency8129Ins Co - Licensed/ActiveOrganizationINDV5591INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA, THEThird PartyDenial Of ClaimNoCompany Position Upheld2012-08-17T00:00:002012-10-25T00:00:00Property and CasualtyHomeownersHomeownersInsured Company2296Ins Co - Licensed/ActiveOrganizationINDV5592HUMANA INSURANCE COMPANYOtherOtherNoInformation Furnished2012-08-17T00:00:002012-10-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationORGCOVERAGE DISPUTE5595FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredPremium NoticeNoInformation Furnished2012-08-17T00:00:002012-10-09T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent2623Ins Co - Licensed/ActiveOrganizationINDV5597HUMANA INSURANCE COMPANYNon-Contracted ProviderUnsatisfactory Settle/OfferNoAdditional Monies Received2012-08-16T00:00:002012-10-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Correspondent Person; Insured1040Self-Funded / ErisaOrganizationORGGR-Claim Evaluation5600STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredCancellation; Premium and RatingNoCorrective Action Taken2012-08-17T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV5600JASMINOY, JAVIER MARCELOInsuredAgent HandlingNoInformation Furnished2012-08-17T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass546373AgentIndividualINDV5602ZURICH AMERICAN INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling)NoClaim Settled2012-08-16T00:00:002012-10-16T00:00:00Property and CasualtyMiscellaneousP & C Misc10087Ins Co - Licensed/ActiveOrganizationINDV5604STATE AUTO PROPERTY & CASUALTY INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoCompany Position Upheld2012-08-17T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass28439Ins Co - Licensed/ActiveOrganizationINDVAFTERMARKET PARTS5605Metroplitan Transit Authority of HarrisThird PartyDelays (Claims Handling)NoNo Jurisdiction; Additional Monies Received2012-08-17T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileBusiness Automobile74110Self-Funded / ErisaOrganizationINDVADJUSTER'S HANDLING5607GEICO INDEMNITY COMPANYInsuredDelays (Claims Handling)NoCompany Position Upheld2012-08-16T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass2785Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED5610MOUNTAIN WEST INSURANCE & FINANCIAL SERVICES LLCInsuredPremium and RatingNoInformation Furnished; Contract Language/Legal Issue2012-08-17T00:00:002012-10-15T00:00:00Property and CasualtyFire, Allied Lines & CMPBusiness Owners29109Insurance AgencyOrganizationORGUNDERWRITING CRITERIA5611HOMEOWNERS OF AMERICA INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld2012-08-16T00:00:002012-10-19T00:00:00Property and CasualtyHomeownersHomeowners25247Ins Co - Licensed/ActiveOrganizationINDV5612NEWMAN, ISELA MAgentAgent/Agency Contrct TerminYesNo Jurisdiction2012-08-16T00:00:002012-11-07T00:00:00Property and CasualtyMiscellaneousP & C Misc461716AgentIndividualINDV5613STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-08-17T00:00:002012-10-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; DAMAGE DISPUTE; UNDERWRITING CRITERIA5613COFFEE, WILLIAM CLINTONInsuredAgent HandlingNoInformation Furnished2012-08-17T00:00:002012-10-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass19213AgentIndividualINDVCOVERAGE DISPUTE; DAMAGE DISPUTE; UNDERWRITING CRITERIA5616MIDLANDS MANAGEMENT CORPORATIONAgentOther; Unauthorized ActsYesInsufficient Information2012-08-16T00:00:002013-01-04T00:00:00Property and CasualtyMiscellaneousWatercraftAssociated Subject Company9348Insurance AgencyOrganizationINDV5617UNITEDHEALTHCARE INSURANCE COMPANYInsuredAccess to Care; Balance Billing; Delays In AuthorizationNoNo Jurisdiction2012-08-16T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person; Insured1348Self-Funded / ErisaOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation5618ACCC INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Question of Fact2012-08-17T00:00:002012-10-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDV5619UNITED SERVICES AUTOMOBILE ASSOCIATIONThird PartyCust Service Claim HandlingNoNo Jurisdiction; Information Furnished2012-08-17T00:00:002012-11-13T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1254Ins Co - Licensed/ActiveOrganizationINDVCOMPARATIVE NEGLIGENCE5625TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICAThird PartyDelays (Claims Handling)NoQuestion of Fact; Information Furnished; Additional Payment Expected2012-08-16T00:00:002012-12-13T00:00:00Property and CasualtyMiscellaneousFidelity & Surety3714Ins Co - Licensed/ActiveOrganizationINDV5626AMICA MUTUAL INSURANCE COMPANYThird PartyUnfair Discrim-Clms Handling; Unsatisfactory Settle/OfferNoCompany Position Upheld2012-08-17T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private Pass3532Ins Co - Licensed/ActiveOrganizationINDV5628OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished; Question of Fact2012-08-20T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; LOSS OF USE5630ESURANCE INSURANCE COMPANYInsuredPremium and RatingNoCompany Position Upheld2012-08-17T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent1350Ins Co - Licensed/ActiveOrganizationINDV5631CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling); Delays (Underwriting); Timely Filing DeficiencyNoNo Jurisdiction2012-08-16T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Self-Funded / ErisaOrganizationORGGR-Claim Evaluation5632SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.Third PartyDenial Of ClaimNoNo Jurisdiction2012-08-17T00:00:002012-10-10T00:00:00Property and CasualtyLiabilityGeneral LiabilityInsured Company54345Third Party AdministratorsOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation5633STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received2012-08-17T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVLOSS OF USE5635PROGRESSIVE CASUALTY INSURANCE COMPANYAttorneyDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-08-17T00:00:002012-10-12T00:00:00Property and CasualtyMiscellaneousWatercraftInsured1763Ins Co - Licensed/ActiveOrganizationORG5636FARMERS INSURANCE EXCHANGEOtherUnsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received2012-08-20T00:00:002012-10-09T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person; Insured2668Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation; OVERHEAD AND PROFIT5637SOUTHWEST LIFE & HEALTH INSURANCE COMPANYInsuredDelays In Authorization; Denial Of ClaimNoContract Language/Legal Issue2012-08-16T00:00:002012-12-06T00:00:00Health Maintenance OrgAccident and HealthGroup A&HAssociated Subject Company2041Health Maintenance OrgOrganizationINDVEMERGENCY CARE; GR-Claim Evaluation5638FARMERS INSURANCE EXCHANGEInsuredBalance Billing; Premium NoticeNoInformation Furnished; Company Position Upheld2012-08-16T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass2668Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA5639RANCHERS AND FARMERS MUTUAL INSURANCE COMPANYInsuredCancellationNo2012-08-17T00:00:002012-10-21T00:00:00Property and CasualtyHomeownersHomeownersInsured1689Ins Co - Licensed/ActiveOrganizationINDV5639ESTRELLA INSURANCE AGENCY, INC.InsuredDelays (Policyholder Service)NoClaim Settled2012-08-17T00:00:002012-10-21T00:00:00Property and CasualtyHomeownersHomeownersInsured14748Insurance AgencyOrganizationINDV5640MERCURY COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld2012-08-16T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company1693Ins Co - Licensed/ActiveOrganizationINDV5641BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of Claim; SB418 Rule Violation; Timely Filing DeficiencyNoInformation Furnished2012-08-16T00:00:002014-02-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation5642ALFA VISION INSURANCE CORPORATIONInsuredRefund Of PremiumYesInformation Furnished2012-08-16T00:00:002012-12-18T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent22105Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA5643TRINITY UNIVERSAL INSURANCE COMPANYInsuredNon-RenewalYesInformation Furnished2012-08-16T00:00:002012-12-17T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1353Ins Co - Licensed/ActiveOrganizationINDV5644PROPERTY AND CASUALTY INSURANCE COMPANY OF HARTFORDInsuredDelays (Claims Handling)NoClaim Settled2012-09-12T00:00:002012-10-12T00:00:00Property and CasualtyHomeownersHomeowners8123Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING5645HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.ProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-20T00:00:002012-10-23T00:00:00Medicare HMOAccident and HealthIndividual A & HAssociated Subject Company; Insured27417Health Maintenance OrgOrganizationORGGR-Claim Evaluation; SENIOR CITIZEN5647ALLSTATE TEXAS LLOYD'SInsuredUnsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished2012-08-17T00:00:002012-10-19T00:00:00Property and CasualtyHomeownersHomeowners3721Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; ROOF5651STATE FARM LLOYDSInsuredPremium and RatingNoInformation Furnished; Company Position Upheld2012-08-17T00:00:002012-10-21T00:00:00Property and CasualtyHomeownersMobile Homeowner3105Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNDERWRITING CRITERIA5651PAUL, TIMOTHY LEEInsuredAgent HandlingNoInformation Furnished; Question of Fact2012-08-17T00:00:002012-10-21T00:00:00Property and CasualtyHomeownersMobile Homeowner347573AgentIndividualINDVCOVERAGE DISPUTE; UNDERWRITING CRITERIA5657GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredDelays (Claims Handling)NoClaim Settled2012-08-20T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent2486Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; SUBROGATION5663UNITEDHEALTHCARE INSURANCE COMPANYInsuredBalance Billing; Out Of Ntwk Referral; Unsatisfactory Settle/OfferYesClaim Settled2012-08-20T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured1348Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5670A-MAX INSURANCE SERVICES, INC.Consumer (Non-Insured)Agent HandlingNoQuestion of Fact2012-08-20T00:00:002012-12-11T00:00:00Property and CasualtyAutomobileIndividual Private Pass23301Insurance AgencyOrganizationINDV5674TEXAS WINDSTORM INSURANCE ASSOCIATIONConsumer (Non-Insured)Unsatisfactory Settle/OfferNoContract Language/Legal Issue2012-08-17T00:00:002012-10-10T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied LinesInsured1444TWIAOrganizationINDVHAIL; ROOF5678ING LIFE INSURANCE AND ANNUITY COMPANYInsuredCash ValueNoInformation Furnished2012-08-16T00:00:002012-10-29T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured Company197Ins Co - Licensed/ActiveOrganizationINDV5683GULF COAST ADJUSTMENT SERVICE OF HOUSTON, INC.Third PartyCust Service Claim Handling; Delays (Claims Handling)YesClaim Settled; Information Furnished2012-08-20T00:00:002012-10-21T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines54120Third Party AdministratorsOrganizationORGADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; UNCOOPERATIVE INSURED5684LIFE INSURANCE COMPANY OF NORTH AMERICAInsuredDenial Of ClaimNoInformation Furnished; No Jurisdiction2012-08-16T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company2157Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE5685OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredRefund Of PremiumYesInformation Furnished2012-08-20T00:00:002012-11-01T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA5686UNITEDHEALTHCARE INSURANCE COMPANYInsuredCust Service Claim HandlingNoNo Jurisdiction2012-08-16T00:00:002012-10-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; MATERNITY5686BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoInsufficient Information2012-08-16T00:00:002012-10-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; MATERNITY5687STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXASThird PartyDenial Of Claim; Liability DisputeNoQuestion of Fact2012-08-20T00:00:002012-10-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass1506Ins Co - Licensed/ActiveOrganizationINDV5687STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyLiability DisputeNo2012-08-20T00:00:002012-10-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV5688CENTRAL STATES HEALTH & LIFE CO. OF OMAHAInsuredDenial Of ClaimNoCancel/Non-Renewal Upheld2012-08-20T00:00:002012-10-21T00:00:00Life, Accident and HealthAccident and HealthCredit Disability2909Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5689INDEPENDENT ORDER OF FORESTERS, THEAgentAgency Balance; CommissionsYesInformation Furnished2012-08-09T00:00:002012-11-28T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life13242Ins Co - Licensed/ActiveOrganizationINDV5692NORTH AMERICA LIFE INSURANCE COMPANYRelativeCash ValueNoNo Jurisdiction; Information Furnished2012-08-11T00:00:002012-10-29T00:00:00Life, Accident and HealthLife & AnnuityPre-Paid Funeral PlanAssociated Subject Company; Insured1897Ins Co - Licensed/ActiveOrganizationINDV5696R.V.O.S. FARM MUTUAL INSURANCE COMPANYInsuredPremium and RatingNoCorrective Action Taken; Information Furnished2012-08-16T00:00:002013-01-30T00:00:00Property and CasualtyHomeownersHomeowners2621Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA5696HAVLAK, HARVEY JAMESInsuredAgent HandlingYesInformation Furnished2012-08-16T00:00:002013-01-30T00:00:00Property and CasualtyHomeownersHomeowners184607AgentIndividualINDVUNDERWRITING CRITERIA5700STATE FARM LLOYDSInsuredPremium and RatingNoInformation Furnished2012-08-20T00:00:002012-10-10T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDV5706LIBERTY COUNTY MUTUAL INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)NoCorrective Action Taken; Information Furnished2012-08-20T00:00:002012-10-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass3762Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING5707AMERICAN SAFETY INDEMNITY COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received; Information Furnished; Contract Language/Legal Issue2012-08-20T00:00:002013-02-25T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied LinesAssociated Subject Agency; Associated Subject Person; Correspondent Person56048Ins Co - Surplus LinesOrganizationORGADJUSTER'S HANDLING; GR-Claim Evaluation; TOTAL LOSS5708SLAVONIC MUTUAL FIRE INSURANCE ASSOCIATIONInsuredUnsatisfactory Settle/OfferNoInformation Furnished2012-08-16T00:00:002012-12-06T00:00:00Property and CasualtyHomeownersHomeowners1567Ins Co - Licensed/ActiveOrganizationINDV5708STAVENA, DAN LEEInsuredAgent HandlingNoInformation Furnished2012-08-16T00:00:002012-12-06T00:00:00Property and CasualtyHomeownersHomeowners1918AgentIndividualINDV5710BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredMisrepresentation; Other; PPACA-Appeals And GrievancesYesAdditional Monies Received2012-09-04T00:00:002012-10-05T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HGR Elected Official10047Ins Co - Licensed/ActiveOrganizationINDV5713FARMERS INSURANCE EXCHANGEInsuredPremium and RatingNoCompany Position Upheld2012-08-20T00:00:002012-10-23T00:00:00Property and CasualtyHomeownersHomeowners2668Ins Co - Licensed/ActiveOrganizationINDV5714PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferYesInformation Furnished; Claim Settled2012-08-20T00:00:002012-10-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; AFTERMARKET PARTS; COVERAGE DISPUTE; DAMAGE DISPUTE; GR-Claim Evaluation; LOSS OF USE; REPLACEMENT VEHICLE5715STATE FARM LLOYDSInsuredCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Additional Payment Expected; Appraisal Process Invoked2012-08-20T00:00:002012-10-31T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; GR-Claim Evaluation; HAIL; ROOF5717BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredAccess to Care; Delays In Authorization; Den/N-Pymt MD Nec RXYesContract Language/Legal Issue; Referred To2012-09-07T00:00:002012-11-29T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HGR Elected Official10047Ins Co - Licensed/ActiveOrganizationINDVPRESCRIPTION5719HARTFORD LLOYD'S INSURANCE COMPANYThird PartyCust Service Claim Handling; Denial Of Claim; Liability DisputeYesContract Language/Legal Issue; Information Furnished2012-08-20T00:00:002012-11-30T00:00:00Property and CasualtyLiabilityGeneral LiabilityInsured Company1017Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5728UNITEDHEALTHCARE INSURANCE COMPANYProviderAccess to Care; Denial Of Claim; Ntwk Denial/Termin Of ProvNoContract Language/Legal Issue2012-09-06T00:00:002012-10-30T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HGR Elected Official; Insured1348Self-Funded / ErisaOrganizationORG5735GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Question of Fact2012-08-17T00:00:002012-10-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5737NEW YORK LIFE INSURANCE COMPANYSenior CitizenDelays (Claims Handling)NoContract Language/Legal Issue2012-09-13T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HGR Elected Official; Insured1887Ins Co - Licensed/ActiveOrganizationINDV5741TEXAS FAIR PLAN ASSOCIATIONInsuredCancellationYesInformation Furnished; Corrective Action Taken2012-08-17T00:00:002012-10-19T00:00:00Property and CasualtyHomeownersHomeowners18208Ins Co - Licensed/ActiveOrganizationINDV5742RHI CLAIMS SPECIALIST, INC.Insurance CompanyMisrepresentationYesInsufficient Information2012-09-12T00:00:002012-10-02T00:00:00Property and CasualtyHomeownersHomeowners64642Claims AdjusterOrganizationORG5743MGA INSURANCE COMPANY, INC.InsuredDenial Of ClaimNoCompany Position Upheld2012-08-17T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private Pass812Ins Co - Licensed/ActiveOrganizationINDVDRIVER NOT COVERED5745TRUCK INSURANCE EXCHANGEInsuredNon-RenewalYesCancellation Withdrawn2012-08-20T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileTruckers Policy1355Ins Co - Licensed/ActiveOrganizationINDV5746DELTA DENTAL INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue2012-08-16T00:00:002012-10-09T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company; Correspondent Person; Insured2752Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE5752REPWEST INSURANCE COMPANYConsumer (Non-Insured)Delays (Claims Handling); Denial Of Claim; Liability DisputeNoInformation Furnished; Company Position Upheld2012-09-12T00:00:002012-11-20T00:00:00Property and CasualtyMiscellaneousP & C Misc955Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; UNDERWRITING CRITERIA5755AETNA LIFE INSURANCE COMPANYInsuredDelays (Policyholder Service)NoNo Jurisdiction; Information Furnished2012-09-12T00:00:002012-10-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV5756GERMANIA FARM MUTUAL INSURANCE ASSOCIATIONInsuredCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-09-12T00:00:002012-11-28T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person; Insured2468Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; UNDERWRITING CRITERIA5757AETNA LIFE INSURANCE COMPANYInsuredBalance Billing; Denial Of ClaimNoNo Jurisdiction; Insufficient Information2012-09-12T00:00:002012-12-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company245Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5758STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoClaim Settled; Information Furnished2012-08-24T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVACV; GR-Claim Evaluation; TOTAL LOSS5759UNITED HEALTHCARE SERVICES, INC.ProviderDenial Of ClaimNoNo Jurisdiction2012-08-16T00:00:002012-12-14T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured36825Self-Funded / ErisaOrganizationINDVGR-Claim Evaluation5763CORVEL HEALTHCARE CORPORATIONInjured EmployeeDelays (Claims Handling)NoInformation Furnished; Other2012-09-04T00:00:002012-11-24T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Company54533WC Healthcare Provider NtwkOrganizationINDV5766BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderRecoupment Of Claims Payment; Unsatisfactory Settle/OfferNoCompany Position Upheld; Contract Language/Legal Issue2012-08-16T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation5772TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferNoAppraisal Process Invoked; Question of Fact2012-08-20T00:00:002012-11-01T00:00:00Property and CasualtyHomeownersHomeowners1450Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; DEDUCTIBLE; WATER DAMAGE5773UNITEDHEALTHCARE INSURANCE COMPANYProviderAccess to Care; Den/N-Pymt MD Nec Trmt N-EmrgNoNo Jurisdiction2012-08-16T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5777SAFECO INSURANCE COMPANY OF INDIANAInsuredDenial Of ClaimYesInformation Furnished2012-08-20T00:00:002012-10-12T00:00:00Property and CasualtyHomeownersHomeowners2496Ins Co - Licensed/ActiveOrganizationINDV5778LOYA INSURANCE COMPANYAttorneyCust Service Claim Handling; Delays (Claims Handling)NoNo Jurisdiction; Information Furnished2012-08-20T00:00:002012-10-21T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Correspondent Person; Insured15643Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; GR-Claim Evaluation5779GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Payment Expected; Information Furnished2012-08-21T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF; DAMAGE DISPUTE; DIMINISHED VALUE; GR-Claim Evaluation5782SOUTHERN COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Policyholder Service)NoPolicy Not In Force; Information Furnished2012-08-07T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1583Ins Co - Licensed/ActiveOrganizationINDV5783REASSURE AMERICA LIFE INSURANCE COMPANYBeneficiaryCash Value; Delays (Policyholder Service)NoCompany Position Upheld2012-08-16T00:00:002012-10-31T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person1228Ins Co - Licensed/ActiveOrganizationINDV5786PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling)YesClaim Settled; Information Furnished2012-08-23T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Correspondent Person1708Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING5787TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished2012-08-17T00:00:002012-10-10T00:00:00Property and CasualtyAutomobileIndividual Private Pass1450Ins Co - Licensed/ActiveOrganizationINDVDIMINISHED VALUE; GR-Claim Evaluation; SENIOR CITIZEN5789AMERICAN UNDERWRITERS INSURANCE AGENCYInsuredAgent HandlingNoInformation Furnished2012-08-20T00:00:002012-11-08T00:00:00Property and CasualtyMiscellaneousTitle Insurance73927Insurance AgencyOrganizationINDVUNDERWRITING CRITERIA5790RANCHERS AND FARMERS MUTUAL INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished; Company Position Upheld2012-08-17T00:00:002012-11-25T00:00:00Property and CasualtyHomeownersMobile Homeowner1689Ins Co - Licensed/ActiveOrganizationINDV5790FOREMOST COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and RatingNoCompany Position Upheld; Information Furnished2012-08-17T00:00:002012-11-25T00:00:00Property and CasualtyHomeownersMobile Homeowner2530Ins Co - Licensed/ActiveOrganizationINDV5791OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received2012-08-20T00:00:002012-10-10T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED5792STATE FARM LLOYDSInsuredRefund Of PremiumNoInformation Furnished2012-08-17T00:00:002012-10-22T00:00:00Property and CasualtyLiabilityGeneral LiabilityInsured Company3105Ins Co - Licensed/ActiveOrganizationINDV5792CAMARA, ALONSOInsuredAgent HandlingYesPremium Refunded; Information Furnished2012-08-17T00:00:002012-10-22T00:00:00Property and CasualtyLiabilityGeneral LiabilityInsured Company369291AgentIndividualINDV5793CANAL INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld; Information Furnished2012-08-20T00:00:002012-10-22T00:00:00Property and CasualtyLiabilityGeneral Liability2987Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation; POLICY EXCLUSION; UNDERWRITING CRITERIA5795NATIONAL CASUALTY COMPANYThird PartyLiability DisputeNoQuestion of Fact; Additional Monies Received; Information Furnished2012-08-20T00:00:002012-11-13T00:00:00Property and CasualtyAutomobileTruckers PolicyAssociated Subject Person; Correspondent Person; Insured1997Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; COMPARATIVE NEGLIGENCE; GR-Claim Evaluation; LOSS OF USE; SUBROGATION5797GEICO GENERAL INSURANCE COMPANYInsuredCust Service Claim Handling; Denial Of ClaimNoInformation Furnished; Claim Settled2012-08-17T00:00:002012-10-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass2684Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; TOTAL LOSS5798AMERICAN MODERN HOME INSURANCE COMPANYInsuredDelays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-08-20T00:00:002012-10-21T00:00:00Property and CasualtyHomeownersRental231Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; SENIOR CITIZEN5799ALLSTATE INDEMNITY COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferYesAdditional Monies Received; Information Furnished2012-08-20T00:00:002012-10-23T00:00:00Property and CasualtyHomeownersHomeowners167Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; SUBROGATION; WATER DAMAGE5800AMERICAN MODERN HOME INSURANCE COMPANYInsuredDenial Of ClaimYesAdditional Monies Received; Information Furnished2012-08-20T00:00:002012-11-19T00:00:00Property and CasualtyHomeownersHomeownersDeceased Person231Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE5801GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received; Claim Settled; Additional Payment Expected2012-08-20T00:00:002013-01-02T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation5802ALLSTATE TEXAS LLOYD'SInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-08-20T00:00:002012-10-23T00:00:00Property and CasualtyHomeownersHomeowners3721Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation5802MEZA, OSCAR BInsuredAgent HandlingNoInformation Furnished2012-08-20T00:00:002012-10-23T00:00:00Property and CasualtyHomeownersHomeowners68008AgentIndividualINDVCOVERAGE DISPUTE; GR-Claim Evaluation5803FIRE INSURANCE EXCHANGEInsuredDenial Of ClaimYesClaim Settled2012-08-20T00:00:002012-10-24T00:00:00Property and CasualtyHomeownersHomeowners2606Ins Co - Licensed/ActiveOrganizationINDVHAIL; ROOF5805STATE FARM LLOYDSInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferYesAdditional Monies Received; Information Furnished2012-08-20T00:00:002012-10-22T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; DAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF5806GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoCompany Position Upheld; Question of Fact; Information Furnished2012-08-21T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; DIMINISHED VALUE; GR-Claim Evaluation5807PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of Claim; Unsatisfactory Settle/OfferNoInformation Furnished; Additional Payment Expected2012-08-21T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1708Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COLLEGE FUNDING; COVERAGE DISPUTE; UNDERWRITING CRITERIA5809SAFECO INSURANCE COMPANY OF INDIANAConsumer (Non-Insured)Refusal to InsureNoInformation Furnished2012-08-21T00:00:002012-10-15T00:00:00Property and CasualtyHomeownersHomeowners2496Ins Co - Licensed/ActiveOrganizationINDV5811ALLSTATE INSURANCE COMPANYConsumer (Non-Insured)Liability Dispute; Unrecorded DocumentsNo2012-08-21T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private Pass168Ins Co - Licensed/ActiveOrganizationINDV5811ALLSTATE COUNTY MUTUAL INSURANCE COMPANYConsumer (Non-Insured)Liability DisputeNoCompany Position Upheld2012-08-21T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private Pass2228Ins Co - Licensed/ActiveOrganizationINDV5812LOYA INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld2012-08-21T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass15643Ins Co - Licensed/ActiveOrganizationINDVDRIVER NOT COVERED5813AMICA MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/Offer; Usual And CustomaryYesAdditional Monies Received; Claim Settled2012-08-21T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent3532Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; LOSS OF USE; REPAIR CHOICE; TOTAL LOSS5814FOREMOST COUNTY MUTUAL INSURANCE COMPANYInsuredAgent HandlingYesInformation Furnished; Policy Issued/Restored2012-08-21T00:00:002013-02-05T00:00:00Property and CasualtyHomeownersMobile HomeownerAssociated Subject Agency2530Ins Co - Licensed/ActiveOrganizationINDV5815FARMERS INSURANCE EXCHANGEInsuredPremium and RatingNoCompany Position Upheld2012-08-21T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeowners2668Ins Co - Licensed/ActiveOrganizationINDVACV; HAIL5816USAA CASUALTY INSURANCE COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld2012-08-21T00:00:002012-10-27T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured3607Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5819LERA, DANIEL JORDANInsuredDelays (Claims Handling)NoQuestion of Fact; Information Furnished2012-08-21T00:00:002012-10-25T00:00:00Property and CasualtyLiabilityGeneral LiabilityAssociated Agent606503Public Insurance AdjusterIndividualINDVADJUSTER'S HANDLING5821FIRE INSURANCE EXCHANGEInsuredMisleading Advertising; Non-Disclosure Of CoverageNoInformation Furnished2012-08-21T00:00:002012-11-16T00:00:00Property and CasualtyHomeownersHomeowners2606Ins Co - Licensed/ActiveOrganizationINDVADVERTISING; POLICY EXCLUSION5821HUDSON, ROCKY HEARLInsuredMisleading Advertising; Non-Disclosure Of CoverageNoInformation Furnished2012-08-21T00:00:002012-11-16T00:00:00Property and CasualtyHomeownersHomeowners40768AgentIndividualINDVADVERTISING; POLICY EXCLUSION5822OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYLienholderUnsatisfactory Settle/OfferYesAdditional Monies Received; Information Furnished2012-08-16T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationORGACV; TOTAL LOSS5824STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeNoCompany Position Upheld; Question of Fact; Information Furnished2012-08-21T00:00:002012-10-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5825CANTWELL, HARRY JAMESAgentLicense Application; Unauthorized ActsNoOther2012-08-21T00:00:002012-10-25T00:00:00Property and CasualtyLiabilityMisc Professional Liability185132OtherIndividualINDV5827STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredDenial Of ClaimNoQuestion of Fact2012-08-21T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person1510Ins Co - Licensed/ActiveOrganizationINDVCOMPARATIVE NEGLIGENCE; GR-Claim Evaluation5829TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredPremium and Rating; Windstorm ExclusionNoCompany Position Upheld; Information Furnished2012-08-21T00:00:002012-10-17T00:00:00Property and CasualtyHomeownersHomeowners1444Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; ROOF; UNDERWRITING CRITERIA5830Garcia Insurance AgencyConsumer (Non-Insured)Agent HandlingNoQuestion of Fact2012-08-20T00:00:002013-02-28T00:00:00Property and CasualtyMiscellaneousP & C Misc66295Insurance AgencyOrganizationINDV5831BATTARBEE, LARRY VERNONInsuredConversionYesFailure to Timely Respond; Referred for Disciplinary Actn2012-08-21T00:00:002012-11-30T00:00:00Property and CasualtyLiabilityGeneral LiabilityAssociated Subject Person; Correspondent Person529266AgentIndividualORG5832GRAMERCY INSURANCE COMPANYOtherUnsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-08-21T00:00:002012-12-10T00:00:00Property and CasualtyAutomobileTruckers PolicyAssociated Subject Agency; Correspondent Person; Insured; Insured Company1062Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation5834METROPOLITAN LIFE INSURANCE COMPANYProviderDelays (Claims Handling); Delays (Underwriting)YesClaim Settled2012-08-16T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company13191Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation5835LOYA INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled2012-08-21T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured15643Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF5836TEXAS FARMERS INSURANCE COMPANYInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferYesInformation Furnished; Additional Monies Received2012-08-20T00:00:002012-10-23T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; DAMAGE DISPUTE; GR-Claim Evaluation; ROOF; WATER DAMAGE5837OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYLienholderDenial Of ClaimNoInformation Furnished2012-08-21T00:00:002012-11-15T00:00:00Property and CasualtyAutomobileIndividual Private PassCorrespondent Person; Insured1823Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED5839GERMANIA SELECT INSURANCE COMPANYAttorneyDelays (Claims Handling)YesInformation Furnished; Claim Settled2012-08-20T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person17678Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; GR-Claim Evaluation5840TEXAS FARMERS INSURANCE COMPANYInsuredCancellationNoPremium Refunded2012-08-21T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeownersInsured1452Ins Co - Licensed/ActiveOrganizationINDV5840FADAL, JOHN EDWARDInsuredAgent HandlingNoInformation Furnished2012-08-21T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeownersInsured110053AgentIndividualINDV5841SUPERIOR HEALTHPLAN, INC.Contracted ProviderDenial Of ClaimNoInformation Furnished; No Jurisdiction2012-08-16T00:00:002012-10-18T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured10198Health Maintenance OrgOrganizationINDVGR-Claim Evaluation5842STANDARD CASUALTY COMPANYInsuredEndorsement / RiderNoInformation Furnished2012-08-21T00:00:002012-10-23T00:00:00Property and CasualtyHomeownersHomeowners1552Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF5842MARKEL INTERNATIONAL INSURANCE COMPANY LIMITEDInsuredDenial Of ClaimNoInformation Furnished; Company Position Upheld; Question of Fact2012-08-21T00:00:002012-10-23T00:00:00Property and CasualtyHomeownersHomeowners55933Ins Co - Surplus LinesOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF5843STATE OFFICE OF RISK MANAGEMENTInjured EmployeeDelays (Claims Handling)NoRecord Only2012-08-15T00:00:002012-10-02T00:00:00Life, Accident and HealthMiscellaneousWorkers' Compensation Ntwk68344Govermental EntityOrganizationINDV5845BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling); SB418 Rule Violation; Timely Filing DeficiencyNoNo Jurisdiction2012-08-16T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Self-Funded / ErisaOrganizationORGGR-Claim Evaluation5848NEW ERA LIFE INSURANCE COMPANYConsumer (Non-Insured)Unsatisfactory Settle/OfferNoInformation Furnished; Question of Fact2012-09-14T00:00:002012-11-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1513Ins Co - Licensed/ActiveOrganizationORG5849NATIONWIDE MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoAdditional Monies Received2012-08-21T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass1937Ins Co - Licensed/ActiveOrganizationINDV5850GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeNoInformation Furnished; Question of Fact2012-08-20T00:00:002012-10-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5851ASI LLOYDSInsuredDelays (Claims Handling)YesInformation Furnished; Claim Settled2012-08-21T00:00:002012-10-25T00:00:00Property and CasualtyHomeownersHomeowners14728Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation5852AMERICAN NATIONAL PROPERTY AND CASUALTY COMPANYInsuredOtherNoInformation Furnished2012-08-20T00:00:002012-10-10T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency80Ins Co - Licensed/ActiveOrganizationINDV5853AETNA LIFE INSURANCE COMPANYInsuredDenial Of Claim; Unsatisfactory Settle/OfferNoAdditional Payment Expected; Contract Language/Legal Issue; Information Furnished2012-09-11T00:00:002012-11-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV5856SUPERIOR HEALTHPLAN, INC.Contracted ProviderDenial Of Claim; Timely Filing DeficiencyNoNo Jurisdiction; Information Furnished2012-08-16T00:00:002012-10-29T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured10198Health Maintenance OrgOrganizationORGGR-Claim Evaluation5857FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYAttorneyUnsatisfactory Settle/OfferNoQuestion of Fact2012-08-20T00:00:002012-10-12T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured2623Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation5858FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received2012-08-21T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured2623Ins Co - Licensed/ActiveOrganizationINDV5859LIFE INSURANCE COMPANY OF NORTH AMERICAInsuredDenial Of ClaimNoInformation Furnished; Contract Language/Legal Issue2012-08-16T00:00:002012-11-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2157Ins Co - Licensed/ActiveOrganizationINDV5860TEXAS FARMERS INSURANCE COMPANYInsuredCancellation; Denial Of Claim; Unsatisfactory Settle/OfferNoCancel/Non-Renewal Upheld; Question of Fact; Information Furnished2012-08-21T00:00:002013-02-12T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person1452Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF; WATER DAMAGE5861KAISERConsumer (Non-Insured)Delays (Policyholder Service)NoInsufficient Information2012-08-20T00:00:002012-12-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&H77410Third Party AdministratorsOrganizationINDV5862ONEBEACON AMERICA INSURANCE COMPANYInsuredDelays (Claims Handling)NoContract Language/Legal Issue2012-08-20T00:00:002012-12-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2828Ins Co - Licensed/ActiveOrganizationINDV5863GRAMERCY INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of Claim; Liability DisputeNoInformation Furnished; Question of Fact; Company Position Upheld2012-08-20T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured; Third Party Admin-Non Licensed1062Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; LOSS OF USE5864FARM BUREAU COUNTY MUTUAL INSURANCE COMPANY OF TEXASThird PartyDelays (Claims Handling)YesClaim Settled; Additional Monies Received2012-08-21T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1861Ins Co - Licensed/ActiveOrganizationINDV5866TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYInsuredPremium Notice; Refund Of PremiumYesPremium Refunded2012-08-21T00:00:002012-11-07T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent1450Ins Co - Licensed/ActiveOrganizationINDV5867PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoAppraisal Process Invoked2012-08-20T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDV5868AETNA LIFE INSURANCE COMPANYContracted ProviderDelays (Claims Handling); Usual And CustomaryNoInformation Furnished2012-08-16T00:00:002012-10-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG5869LOYA INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished2012-08-21T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private Pass15643Ins Co - Licensed/ActiveOrganizationINDV5870AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling); Usual And CustomaryNoNo Jurisdiction2012-08-16T00:00:002012-10-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG5871DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling)NoComplainant Retained Attorney; Information Furnished; Company Position Upheld2012-08-21T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; TOTAL LOSS5872STATE FARM LLOYDSInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoContract Language/Legal Issue2012-08-20T00:00:002012-11-06T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVROOF5874ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYConsumer (Non-Insured)Delays (Claims Handling)NoClaim Settled; Information Furnished2012-08-21T00:00:002012-11-06T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING5875GERMAN-AMERICAN FARM MUTUALInsuredRefund Of PremiumYesPremium Refunded2012-08-20T00:00:002012-10-13T00:00:00Property and CasualtyHomeownersMobile Homeowner2467Ins Co - Licensed/ActiveOrganizationINDV5876GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished2012-08-21T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2486Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5878NATIONAL SPECIALTY INSURANCE COMPANYInsuredIncreased Dwelling CoverageNoInformation Furnished2012-08-20T00:00:002012-10-29T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent; Associated Subject Agency; Third Party Admin-Licensed2281Ins Co - Licensed/ActiveOrganizationINDV5879PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Question of Fact2012-08-20T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1708Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; SUBROGATION5880AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-16T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Self-Funded / ErisaOrganizationORGGR-Claim Evaluation5881AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling); Usual And CustomaryNoNo Jurisdiction2012-08-16T00:00:002012-10-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG5882HALLMARK INSURANCE COMPANYInsuredDenial Of ClaimNoInsufficient Information2012-08-09T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeowners24193Ins Co - Licensed/ActiveOrganizationORG5883AETNA LIFE INSURANCE COMPANYContracted ProviderDelays (Claims Handling); Usual And CustomaryNoNo Jurisdiction; Information Furnished2012-08-16T00:00:002012-10-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG5885AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling); Usual And CustomaryNoNo Jurisdiction2012-08-16T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Self-Funded / ErisaOrganizationORG5886AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling); Usual And CustomaryNoInformation Furnished2012-08-16T00:00:002012-11-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG5887AETNA HEALTH INC.Contracted ProviderUnsatisfactory Settle/OfferNoInformation Furnished2012-08-16T00:00:002012-11-13T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured3522Health Maintenance OrgOrganizationORG5888AETNA LIFE INSURANCE COMPANYProviderDenial Of Claim; Medical NecessityNoNo Jurisdiction2012-08-17T00:00:002012-11-06T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured245Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation; SENIOR CITIZEN5889AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling); Usual And CustomaryNoNo Jurisdiction2012-08-16T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG5891CORVEL HEALTHCARE CORPORATIONInjured EmployeePrimary Care Providr SelectionNoInformation Furnished2012-08-17T00:00:002012-12-18T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Company54533WC Healthcare Provider NtwkOrganizationINDV5892SUPERIOR HEALTHPLAN, INC.Contracted ProviderDenial Of ClaimNoNo Jurisdiction2012-08-20T00:00:002012-10-24T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured10198Health Maintenance OrgOrganizationORGEMERGENCY CARE5895AETNA LIFE INSURANCE COMPANYContracted ProviderDelays (Claims Handling); Usual And CustomaryNoNo Jurisdiction2012-08-16T00:00:002012-10-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Self-Funded / ErisaOrganizationORG5897METROPOLITAN LIFE INSURANCE COMPANYProviderDelays (Claims Handling); Timely Filing DeficiencyNoNo Jurisdiction2012-08-20T00:00:002012-10-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured13191Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation5898AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling); Usual And CustomaryNoNo Jurisdiction2012-08-16T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG5901BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDelays (Claims Handling)NoNo Jurisdiction2012-08-20T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDVEMERGENCY CARE; GR-Claim Evaluation5903GLOBE LIFE AND ACCIDENT INSURANCE COMPANYRelativeDelays (Policyholder Service)YesPolicy Issued/Restored; Information Furnished2012-09-14T00:00:002012-10-18T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured917Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; RESCISSION5906AETNA LIFE INSURANCE COMPANYContracted ProviderDelays (Claims Handling); Usual And CustomaryNoNo Jurisdiction; Information Furnished2012-08-16T00:00:002012-10-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG5907AETNA LIFE INSURANCE COMPANYContracted ProviderDelays (Claims Handling); Usual And CustomaryNoContract Language/Legal Issue; Additional Monies Received; Information Furnished2012-08-16T00:00:002012-10-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG5908AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling); Usual And CustomaryNoNo Jurisdiction2012-08-16T00:00:002012-10-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG5910CONNECTICUT GENERAL LIFE INSURANCE COMPANYInsuredDelays (Claims Handling)NoNo Jurisdiction2012-08-20T00:00:002012-10-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Ins Co - Licensed/ActiveOrganizationINDV5912METROPOLITAN LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoCompany Position Upheld2012-09-04T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured13191Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation5917JACKSON NATIONAL LIFE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished2012-09-14T00:00:002012-10-10T00:00:00Life, Accident and HealthLife & AnnuityIndividual Annuities3718Ins Co - Licensed/ActiveOrganizationINDV5918AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-16T00:00:002012-11-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation5920COMBINED INSURANCE COMPANY OF AMERICARelativeRefund Of PremiumNoAdditional Monies Received2012-08-15T00:00:002012-12-17T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured2863Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN5921TEXAS DIRECTORS LIFE INSURANCE COMPANYInsuredOtherNoRecord Only2012-08-09T00:00:002012-10-02T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life930Ins Co - Licensed/ActiveOrganizationINDV5922OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)NoCompany Position Upheld2012-08-21T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private PassCorrespondent Company1823Ins Co - Licensed/ActiveOrganizationINDV5923ALLSTATE COUNTY MUTUAL INSURANCE COMPANYInsuredRefund Of PremiumYesInformation Furnished2012-08-21T00:00:002012-11-02T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent2228Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA5924IMPERIAL FIRE AND CASUALTY INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished2012-08-21T00:00:002012-10-29T00:00:00Property and CasualtyHomeownersHomeowners8486Ins Co - Licensed/ActiveOrganizationINDV5924THEISS, AARON RONALDInsuredAgent HandlingNoInformation Furnished2012-08-21T00:00:002012-10-29T00:00:00Property and CasualtyHomeownersHomeowners338682AgentIndividualINDV5925NATIONAL LLOYDS INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCorrective Action Taken; Additional Monies Received2012-08-21T00:00:002012-11-26T00:00:00Property and CasualtyHomeownersHomeowners1914Ins Co - Licensed/ActiveOrganizationINDV5927STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredDelays (Claims Handling)NoContract Language/Legal Issue2012-08-22T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV5928DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling)NoCompany Position Upheld2012-08-21T00:00:002012-10-17T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2038Ins Co - Licensed/ActiveOrganizationINDV5929CONSOLIDATED LLOYDSInsuredUnsatisfactory Settle/OfferNoClaim Settled; Additional Monies Received; Information Furnished2012-08-22T00:00:002012-10-29T00:00:00Property and CasualtyHomeownersHomeowners2800Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF; SUPPLEMENTARY PAYMENT; TOTAL LOSS5930RODRIGUEZ, GUADALUPE JRInsurance CompanyAgency BalanceYesInformation Furnished2012-08-20T00:00:002012-10-11T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1093837AgentIndividualORG5931SCOTT, LATASHA DENISEInsurance CompanyAgency BalanceYesInformation Furnished2012-08-20T00:00:002012-10-24T00:00:00Property and CasualtyMiscellaneousP & C Misc1073141AgentIndividualORG5932DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled; Additional Monies Received2012-08-22T00:00:002012-10-13T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING5934GERMANIA FARM MUTUAL INSURANCE ASSOCIATIONInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoContract Language/Legal Issue2012-08-22T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeowners2468Ins Co - Licensed/ActiveOrganizationINDVAPPRAISAL; OVERHEAD AND PROFIT5935SAN JACINTO TITLE SERVICES OF TEXAS, LLCConsumer (Non-Insured)OtherNoCompany Position Upheld2012-08-22T00:00:002012-10-15T00:00:00Property and CasualtyMiscellaneousTitle Insurance73567AgentOrganizationINDV5936SOUTHERN COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Question of Fact2012-08-22T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private Pass1583Ins Co - Licensed/ActiveOrganizationINDVDIMINISHED VALUE; GR-Claim Evaluation5937GEICO INDEMNITY COMPANYThird PartyDelays (Claims Handling); Liability DisputeNoAdditional Payment Expected2012-08-22T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2785Ins Co - Licensed/ActiveOrganizationINDV5938ALLSTATE TEXAS LLOYD'SInsuredPremium and RatingNoInformation Furnished2012-08-22T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeowners3721Ins Co - Licensed/ActiveOrganizationINDV5939TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredExcessive Rates; Premium and RatingYesPremium Refunded; Information Furnished2012-08-22T00:00:002012-10-22T00:00:00Property and CasualtyHomeownersHomeowners1444Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA5940UNDERWRITERS AT LLOYD'S, LONDONInsuredUnsatisfactory Settle/OfferNoQuestion of Fact2012-08-22T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeownersCorrespondent Person55949Ins Co - Surplus LinesOrganizationINDVROOF5942COLUMBIA LLOYDS INSURANCE COMPANYInsuredDelays (Claims Handling)NoQuestion of Fact; Information Furnished2012-08-23T00:00:002012-10-30T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent3329Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5943AMICA MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld2012-08-21T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private Pass3532Ins Co - Licensed/ActiveOrganizationINDVREPAIR CHOICE5946OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredCust Service Claim Handling; Denial Of ClaimNoContract Language/Legal Issue2012-08-22T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDV5948OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYLienholderCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferNoOther2012-08-22T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationORG5949ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling)YesClaim Settled; Information Furnished2012-08-22T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured936Ins Co - Licensed/ActiveOrganizationINDV5951CONSOLIDATED LLOYDSInsuredDenial Of ClaimNoCompany Position Upheld; Information Furnished2012-08-22T00:00:002012-10-23T00:00:00Property and CasualtyHomeownersMobile Homeowner2800Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; MOLD; WATER DAMAGE5953UNITRIN COUNTY MUTUAL INSURANCE COMPANYThird PartyMedical Necessity; Unsatisfactory Settle/Offer; Usual And CustomaryNoClaim Settled2012-08-22T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass1856Ins Co - Licensed/ActiveOrganizationINDV5954PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled; Additional Monies Received2012-08-22T00:00:002012-12-04T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1708Ins Co - Licensed/ActiveOrganizationINDVCOMPARATIVE NEGLIGENCE; GR-Claim Evaluation5955TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-08-22T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent1450Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE5955MADDEN, DAVID LEON JRInsuredAgent HandlingNo2012-08-22T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent224904AgentIndividualINDVDEDUCTIBLE5957DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled; Additional Monies Received2012-08-22T00:00:002012-10-13T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE5958OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled2012-08-23T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1823Ins Co - Licensed/ActiveOrganizationINDV5959USAA GENERAL INDEMNITY COMPANYInsuredAssignment of Benefits; Delays (Claims Handling); Denial Of ClaimNoAdditional Monies Received2012-08-22T00:00:002012-11-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass1276Ins Co - Licensed/ActiveOrganizationINDV5960STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished2012-09-17T00:00:002012-10-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV5961STATE FARM LLOYDSInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished2012-08-22T00:00:002012-10-25T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent3105Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF5962FUNERAL DIRECTORS LIFE INSURANCE COMPANYConsumer (Non-Insured)Unsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-08-16T00:00:002012-10-30T00:00:00Life, Accident and HealthLife & AnnuityPre-Paid Funeral PlanAssociated Subject Company; Insured1177Ins Co - Licensed/ActiveOrganizationORG5964RANCHERS AND FARMERS INSURANCE COMPANYThird PartyDelays (Claims Handling)YesInformation Furnished2012-08-22T00:00:002013-01-28T00:00:00Property and CasualtyHomeownersHomeownersInsured20264Ins Co - Licensed/ActiveOrganizationINDV5965OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-08-23T00:00:002012-10-13T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVSUBROGATION5967GOVERNMENT EMPLOYEES INSURANCE COMPANYLienholderUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-08-22T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationORG5969PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredRefund Of PremiumNoPremium Refunded2012-08-23T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileBusiness Automobile1708Ins Co - Licensed/ActiveOrganizationORG5970FOREMOST COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoQuestion of Fact2012-08-22T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private Pass2530Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation5970FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-08-22T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation5971LOYA INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling); Denial Of ClaimNoContract Language/Legal Issue2012-08-21T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass15643Ins Co - Licensed/ActiveOrganizationINDV5972HOME STATE COUNTY MUTUAL INSURANCE COMPANYConsumer (Non-Insured)Denial Of ClaimNoContract Language/Legal Issue; Complainant Retained Attorney2012-08-22T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured Company2362Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; DRIVER NOT COVERED5973ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredCancellation; Denial Of ClaimNoPolicy Not In Force; Information Furnished2012-08-23T00:00:002012-10-23T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent936Ins Co - Licensed/ActiveOrganizationINDV5973AUGUSTINE, AARON EUGENEInsuredAgent HandlingYesInformation Furnished2012-08-23T00:00:002012-10-23T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent360288AgentIndividualINDV5975EPIC LONE STAR SOLUTIONS, LLCConsumer (Non-Insured)OtherNoCompany Position Upheld2012-08-22T00:00:002012-10-15T00:00:00Property and CasualtyMiscellaneousTitle InsuranceAssociated Subject Person74001AgentOrganizationINDV5976YOUNG, TIFFANYConsumer (Non-Insured)Cancellation; Unauthorized ActsNoNo Jurisdiction2012-08-22T00:00:002013-01-14T00:00:00Property and CasualtyMiscellaneousP & C Misc879427AgentIndividualINDV5977HOME STATE COUNTY MUTUAL INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferYesInformation Furnished; Claim Settled2012-08-23T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Person2362Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE5978LOYA INSURANCE COMPANYThird PartyDenial Of ClaimNoContract Language/Legal Issue; Company Position Upheld2012-08-22T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private Pass15643Ins Co - Licensed/ActiveOrganizationINDVDRIVER NOT COVERED; GR-Claim Evaluation5979OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)NoInformation Furnished2012-08-23T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVSUBROGATION; UNCOOPERATIVE INSURED5981USAA CASUALTY INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoCompany Position Upheld2012-08-23T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private Pass3607Ins Co - Licensed/ActiveOrganizationINDV5984UMR, INC.ProviderDelays (Claims Handling); Timely Filing DeficiencyNoNo Jurisdiction2012-08-16T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured23490Self-Funded / ErisaOrganizationORGGR-Claim Evaluation5985OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-08-23T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation5986PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld2012-08-23T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDV5987HOCHHEIM PRAIRIE FARM MUTUAL INSURANCE ASSOCIATIONInsuredDenial Of ClaimNoInformation Furnished2012-08-23T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeowners2350Ins Co - Licensed/ActiveOrganizationINDV5989METROPOLITAN LLOYDS INSURANCE COMPANY OF TEXASInsuredBalance Billing; Premium NoticeYesInformation Furnished2012-08-22T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass3848Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA5990STATE FARM LLOYDSInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Question of Fact2012-08-23T00:00:002012-11-01T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVROOF5991BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-08-17T00:00:002012-10-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Self-Funded / ErisaOrganizationORGGR-Claim Evaluation5992TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)NoInformation Furnished2012-08-22T00:00:002012-11-03T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured1450Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation5993TEXAS FARMERS INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoQuestion of Fact; Information Furnished; Company Position Upheld2012-08-22T00:00:002012-10-23T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; MOLD; ROOF; WATER DAMAGE5996CONNECTICUT GENERAL LIFE INSURANCE COMPANYOtherUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-17T00:00:002012-10-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Self-Funded / ErisaOrganizationORGGR-Claim Evaluation5997PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYLienholderDelays (Claims Handling); Liability DisputeNoCompany Position Upheld2012-08-23T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE5998RENTAL INSURANCE SERVICESThird PartyUnsatisfactory Settle/OfferNoNo Jurisdiction; Question of Fact2012-08-23T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured Company74006Self-Funded / ErisaOrganizationINDVGR-Claim Evaluation5999PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferYesAdditional Monies Received2012-08-23T00:00:002012-10-29T00:00:00Property and CasualtyHomeownersHomeownersInsured1708Ins Co - Licensed/ActiveOrganizationINDV6002NATIONAL LLOYDS INSURANCE COMPANYInsuredDenial Of ClaimYesClaim Settled2012-08-23T00:00:002012-10-29T00:00:00Property and CasualtyHomeownersHomeowners1914Ins Co - Licensed/ActiveOrganizationINDV6003ESURANCE INSURANCE COMPANYInsuredRefusal to InsureNoInformation Furnished2012-08-23T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private Pass1350Ins Co - Licensed/ActiveOrganizationINDV6005MCCOMBS, KERRY ALANInsuredAgent HandlingYesQuestion of Fact2012-08-23T00:00:002012-11-16T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person30123AgentIndividualINDV6007ACCC INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoCompany Position Upheld; Question of Fact2012-08-23T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured9825Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation6008USAA CASUALTY INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished2012-08-23T00:00:002012-11-20T00:00:00Property and CasualtyAutomobileIndividual Private Pass3607Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; TOTAL LOSS; UNDERWRITING CRITERIA6008EASYCARE%InsuredCust Service Claim Handling; Delays (Claims Handling)NoClaim Settled; Information Furnished2012-08-23T00:00:002012-11-20T00:00:00Property and CasualtyAutomobileIndividual Private Pass74011Insurance AgencyOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; TOTAL LOSS; UNDERWRITING CRITERIA6013DRIVER'S INSURANCE COMPANYInsuredClaimant Fraud; Denial Of ClaimYesPolicy Not In Force2012-08-23T00:00:002012-11-29T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Associated Subject Agency2038Ins Co - Licensed/ActiveOrganizationINDV6013FUENTES, SAMIRAInsuredUnauthorized ActsYesReferred for Disciplinary Actn; No Enforcement Case Opened2012-08-23T00:00:002012-11-29T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Associated Subject Agency1149464Unauthorized ActivityIndividualINDV6014BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderRecoupment Of Claims Payment; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-17T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation6015PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYConsumer (Non-Insured)Cancellation; Refund Of PremiumNoCompany Position Upheld2012-08-23T00:00:002012-10-25T00:00:00Property and CasualtyLiabilityGeneral Liability1708Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE6017PACHICANO, TRINIDADOtherAgent Handling; ConversionYesReferred for Disciplinary Actn; Failure to Timely Respond2012-08-23T00:00:002013-01-24T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Insured662788AgentIndividualORG6018SOUTHERN COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and Rating; Refund Of PremiumNoPremium Refunded; Additional Payment Expected; Information Furnished2012-08-23T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company1583Ins Co - Licensed/ActiveOrganizationINDV6019BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderCust Service Claim Handling; Recoupment Of Claims Payment; Unsatisfactory Settle/OfferNoInformation Furnished2012-08-17T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation6020DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Question of Fact2012-08-23T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured2038Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; LOSS OF USE6021TEXAS FARMERS INSURANCE COMPANYInsuredDelays (Claims Handling); Usual And CustomaryNoQuestion of Fact2012-08-23T00:00:002012-10-12T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company1452Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; HAIL; ROOF6022ALLSTATE COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeNoQuestion of Fact; Information Furnished2012-08-23T00:00:002012-10-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass2228Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6023TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredCancellationNoInformation Furnished2012-08-23T00:00:002012-10-29T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent1444Ins Co - Licensed/ActiveOrganizationINDVHAIL; ROOF6024PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeYesQuestion of Fact; Information Furnished2012-09-14T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDV6025BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredBalance Billing; Unsatisfactory Settle/Offer; Usual And CustomaryNoContract Language/Legal Issue2012-08-17T00:00:002012-10-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Injured EmployeeOrganizationINDVEMERGENCY CARE; GR-Claim Evaluation6026LOYA INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeNoQuestion of Fact2012-08-23T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass15643Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6029UNDERWRITERS AT LLOYD'S, LONDONInsuredCancellationNoInformation Furnished2012-08-23T00:00:002012-11-30T00:00:00Property and CasualtyLiabilityGeneral LiabilityCorrespondent Person55949Ins Co - Surplus LinesOrganizationORG6029BATTARBEE, LARRY VERNONInsuredConversionYesReferred for Disciplinary Actn; Failure to Timely Respond2012-08-23T00:00:002012-11-30T00:00:00Property and CasualtyLiabilityGeneral LiabilityCorrespondent Person529266AgentIndividualORG6032UNITEDHEALTHCARE INSURANCE COMPANYInsuredCust Service Claim Handling; OtherNoNo Jurisdiction2012-08-17T00:00:002012-10-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person1348Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6034BEACON NATIONAL INSURANCE COMPANYInsuredDenial Of Claim; Non-RenewalNoInformation Furnished; Contract Language/Legal Issue2012-08-23T00:00:002012-11-27T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied LinesAssociated Agent; Insured3049Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6037MAIALE, DIANE RANAEAgentOtherNoInformation Furnished2012-08-17T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured854501AgentIndividualINDV6040TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredRefund Of PremiumNoInformation Furnished2012-08-23T00:00:002012-10-12T00:00:00Property and CasualtyHomeownersHomeowners GroupAssociated Subject Agency1444TWIAOrganizationINDV6040BROCK, STEPHANIE RENEEInsuredAgent HandlingNoInformation Furnished2012-08-23T00:00:002012-10-12T00:00:00Property and CasualtyHomeownersHomeowners GroupAssociated Subject Agency686294AgentIndividualINDV6041MEPCO INSURANCE PREMIUM FINANCING, INC.InsuredNot Within TDI JurisdictionNoNo Jurisdiction2012-08-17T00:00:002013-02-15T00:00:00Property and CasualtyMiscellaneousWarranty ContractAssociated Subject Company48616OtherOrganizationINDVADJUSTER'S HANDLING; UNDERWRITING CRITERIA6042RODRIGUEZ, JESUS CInsurance CompanyAgent HandlingYesPolicy Issued/Restored2012-08-22T00:00:002012-11-19T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Insured230095AgentIndividualORG6043ALLIED BENEFIT SYSTEMS, INC.ProviderDenial Of Claim; Timely Filing DeficiencyNoNo Jurisdiction2012-08-17T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Correspondent Company; Insured34916Self-Funded / ErisaOrganizationORGGR-Claim Evaluation6047STATE FARM LLOYDSInsuredUnsatisfactory Settle/OfferYesAdditional Monies Received; Additional Payment Expected; Information Furnished2012-09-09T00:00:002012-10-23T00:00:00Property and CasualtyHomeownersHomeownersInsured3105Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; UNDERWRITING CRITERIA6048BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnfair Discrim-Clms HandlingNoNo Jurisdiction2012-08-17T00:00:002012-10-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Third Party AdministratorsOrganizationORG6049AETNA LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-08-17T00:00:002012-10-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Self-Funded / ErisaOrganizationORG6051BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONContracted ProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-17T00:00:002012-10-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Self-Funded / ErisaOrganizationORG6052BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished2012-08-17T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG6054AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/Offer; Usual And CustomaryNoNo Jurisdiction2012-08-17T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Self-Funded / ErisaOrganizationORG6056UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-17T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Self-Funded / ErisaOrganizationORGGR-Claim Evaluation6057AITKEN, CHRISInsuredMisrepresentationNoQuestion of Fact; Information Furnished2012-08-17T00:00:002012-11-28T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life12204AgentIndividualINDV6057METROPOLITAN LIFE INSURANCE COMPANYInsuredMisrepresentationNoInformation Furnished2012-08-17T00:00:002012-11-28T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life13191Ins Co - Licensed/ActiveOrganizationINDV6057LABOVITZ, HARRYInsuredMisrepresentationNoInformation Furnished2012-08-17T00:00:002012-11-28T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life704910AgentIndividualINDV6058SOUTHERN LIFE AND HEALTH INSURANCE COMPANYRelativeDelays (Policyholder Service)NoInformation Furnished2012-08-17T00:00:002012-11-30T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company; Insured880Ins Co - Licensed/ActiveOrganizationINDV6060DELTA DENTAL OF CALIFORNIARelativeContinuity Of TreatmentNoInformation Furnished; Question of Fact2012-08-17T00:00:002013-01-16T00:00:00Children Health Insurance PlanAccident and HealthGroup A&HAssociated Subject Person; Insured44231Health Maintenance OrgOrganizationINDV6067TricareProviderNot Within TDI JurisdictionNoReferred To2012-08-17T00:00:002012-09-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured67890Govermental EntityOrganizationORG6070UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-09-18T00:00:002012-10-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGBUNDLING; GR-Claim Evaluation6072AETNA LIFE INSURANCE COMPANYInsuredCOBRANoNo Jurisdiction; Information Furnished2012-08-20T00:00:002012-10-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV6073AETNA LIFE INSURANCE COMPANYInsuredDelays (Claims Handling)NoNo Jurisdiction; Information Furnished; Additional Payment Expected2012-08-20T00:00:002012-10-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDV6074SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.InsuredUnsatisfactory Settle/OfferNoComplainant Retained Attorney2012-08-20T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company34661Self-Funded / ErisaOrganizationINDV6077UNITEDHEALTHCARE INSURANCE COMPANYInsuredDelays (Policyholder Service)NoContract Language/Legal Issue; Information Furnished2012-08-20T00:00:002012-11-05T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1348Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE6081AMERICAN GENERAL LIFE INSURANCE COMPANYInsuredCash ValueNoContract Language/Legal Issue; Company Position Upheld2012-08-20T00:00:002012-10-31T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life152Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6082BANKERS LIFE AND CASUALTY COMPANYConsumer (Non-Insured)MisrepresentationNoInformation Furnished2012-08-20T00:00:002012-11-07T00:00:00Life, Accident and HealthMiscellaneousNo Line Specified3030Ins Co - Licensed/ActiveOrganizationINDV6087UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDenial Of Claim; Medical NecessityNoContract Language/Legal Issue; Information Furnished2012-09-18T00:00:002012-10-18T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGPRESCRIPTION6094American National Insurance CompanyBeneficiaryDenial Of ClaimNoClaim Settled2012-08-20T00:00:002012-10-17T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person75483Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6100NATIONAL CHOICECARE, NCC CHOICENETPhysicianOtherYesFailure to Timely Respond; No Jurisdiction2012-08-21T00:00:002013-03-21T00:00:00Workers' CompensationAccident and HealthGroup A&H54523OtherOrganizationORG6107TEXAS FARMERS INSURANCE COMPANYInsuredDenial Of Claim; Premium and RatingNoInformation Furnished2012-09-06T00:00:002012-11-02T00:00:00Property and CasualtyHomeownersHomeownersInsured1452Ins Co - Licensed/ActiveOrganizationINDVROOF6108AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-21T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Self-Funded / ErisaOrganizationORGGR-Claim Evaluation6110BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoNo Jurisdiction2012-08-21T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Self-Funded / ErisaOrganizationINDVEXPERIMENTAL/INVESTIGATIONAL6112OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYAttorneyDenial Of ClaimYesContract Language/Legal Issue2012-09-17T00:00:002012-11-05T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured; Third Party Admin-Non Licensed1823Ins Co - Licensed/ActiveOrganizationINDV6124AETNA LIFE INSURANCE COMPANYPhysicianOtherNoOther2012-08-21T00:00:002012-12-10T00:00:00Life, Accident and HealthMiscellaneousNo Line Specified245Ins Co - Licensed/ActiveOrganizationINDV6125BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUsual And CustomaryNoCompany Position Upheld; Contract Language/Legal Issue2012-08-21T00:00:002012-10-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV6127UNITEDHEALTHCARE INSURANCE COMPANYInsuredBalance Billing; Unsatisfactory Settle/OfferNoContract Language/Legal Issue2012-08-10T00:00:002012-10-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company1348Ins Co - Licensed/ActiveOrganizationINDVCANCER; GR-Claim Evaluation6131NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA.InsuredDenial Of ClaimNoContract Language/Legal Issue2012-09-04T00:00:002012-11-07T00:00:00Property and CasualtyMiscellaneousTravelAssociated Subject Company; Insured; Third Party Admin-Non Licensed1931Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING6135MILLER, STANLEY GEORGEInsurance CompanyMisrepresentationYesInsufficient Information2012-09-11T00:00:002012-10-09T00:00:00Property and CasualtyHomeownersHomeowners Group173892Public Insurance AdjusterIndividualORG6151AETNA LIFE INSURANCE COMPANYInsuredAccess to Care; Delays (Claims Handling); Medical Necessity; Out Of Ntwk ReferralNoNo Jurisdiction2012-08-21T00:00:002012-10-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Self-Funded / ErisaOrganizationINDVGR-Claim Evaluation6153JASON POSES & ASSOCIATES, INC.Insurance CompanyMisrepresentationNoInformation Furnished2012-09-11T00:00:002012-10-02T00:00:00Property and CasualtyHomeownersHomeowners GroupAssociated Agent; Insured36910Public Insurance AdjusterOrganizationORG6158METROPOLITAN LIFE INSURANCE COMPANYProviderDelays (Claims Handling); Timely Filing DeficiencyNoNo Jurisdiction2012-08-20T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured13191Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation6159RILEY, JOSHInsurance CompanyFraudNoInsufficient Information2012-09-07T00:00:002012-11-14T00:00:00Property and CasualtyHomeownersHomeownersInsured1150055OtherIndividualINDVHAIL; ROOF6162UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-08-17T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Self-Funded / ErisaOrganizationINDVGR-Claim Evaluation6163ERWIN, JOHN ROGERInsurance CompanyMisrepresentationYesInsufficient Information2012-09-17T00:00:002012-10-11T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines1102693Public Insurance AdjusterIndividualORG6164LIFE INSURANCE COMPANY OF NORTH AMERICAInsuredDenial Of ClaimNoOther; Claim Settled; Additional Monies Received2012-09-10T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthCredit Disability2157Ins Co - Licensed/ActiveOrganizationINDV6166NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA.InsuredDelays (Claims Handling)YesInformation Furnished2012-08-15T00:00:002012-10-22T00:00:00Property and CasualtyLiabilityGeneral Liability1931Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6175UNITEDHEALTHCARE INSURANCE COMPANYProviderRecoupment Of Claims Payment; Unsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-08-20T00:00:002012-11-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6180RELIABLE LIFE INSURANCE COMPANY, THEInsuredCash ValueNoContract Language/Legal Issue2012-08-20T00:00:002013-03-20T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1704Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE6183PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANYBeneficiaryDelays (Claims Handling)NoInformation Furnished; Contract Language/Legal Issue2012-08-20T00:00:002012-11-01T00:00:00Life, Accident and HealthLife & AnnuityGroup AnnuitiesDeceased Person3618Ins Co - Licensed/ActiveOrganizationINDV6184UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction; Referred To2012-08-20T00:00:002012-10-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation6185STOLTZ AND COMPANY LTD LLPAgentCommissionsNoNo Jurisdiction2012-08-21T00:00:002012-10-25T00:00:00Property and CasualtyMiscellaneousP & C Misc10218AgentOrganizationORG6186ELMORE, JAMES ROBERTOtherOtherNoQuestion of Fact2012-08-22T00:00:002012-10-31T00:00:00Property and CasualtyHomeownersHomeownersInsured774206Public Insurance AdjusterIndividualINDVAPPRAISAL6188AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling); Timely Filing DeficiencyNoNo Jurisdiction2012-08-21T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Self-Funded / ErisaOrganizationORGBUNDLING; GR-Claim Evaluation6190AETNA LIFE INSURANCE COMPANYInsuredDelays (Underwriting)NoInformation Furnished; Policy Issued/Restored2012-08-21T00:00:002012-10-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV6192ALLSTATE INDEMNITY COMPANYInsuredOtherNoInformation Furnished2012-08-23T00:00:002012-11-06T00:00:00Property and CasualtyMiscellaneousNo Line Specified167Ins Co - Licensed/ActiveOrganizationINDV6192COMPLETE COVERAGE INSURANCE, LLPInsuredAgent HandlingNoInformation Furnished2012-08-23T00:00:002012-11-06T00:00:00Property and CasualtyMiscellaneousNo Line Specified21030AgentOrganizationINDV6196UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling); Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-21T00:00:002012-10-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG6197UNITEDHEALTHCARE INSURANCE COMPANYPhysicianDelays (Claims Handling); Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-20T00:00:002012-10-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV6199JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.)InsuredRefund Of PremiumNoInformation Furnished; Contract Language/Legal Issue2012-08-20T00:00:002012-11-01T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1148Ins Co - Licensed/ActiveOrganizationINDV6200AAA TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredRefund Of PremiumYesPremium Refunded; Information Furnished2012-08-23T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersRentalAssociated Agent2286Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA6201UNITEDHEALTHCARE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferYesClean Claims Violation2012-08-20T00:00:002012-11-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGBUNDLING; GR-Claim Evaluation6202VASQUEZ BONDS, SYLVIAAgentUnauthorized ActsNoOther2012-08-21T00:00:002012-11-02T00:00:00Property and CasualtyAutomobileIndividual Private Pass664344AgentIndividualINDV6204UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of Claim; Medical Necessity; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-20T00:00:002012-10-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGBUNDLING; GR-Claim Evaluation6207UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction; Information Furnished2012-08-20T00:00:002012-10-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Self-Funded / ErisaOrganizationORG6208UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-08-20T00:00:002012-10-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation6209HUMANA INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction; Additional Monies Received2012-08-20T00:00:002013-04-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation6210AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-20T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Self-Funded / ErisaOrganizationORG6211CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-08-20T00:00:002012-11-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Self-Funded / ErisaOrganizationORG6213HUMANA INSURANCE COMPANYOtherRecoupment Of Claims PaymentNoNo Jurisdiction2012-09-19T00:00:002012-10-27T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1040Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation6214TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredRefund Of PremiumNoCompany Position Upheld2012-09-10T00:00:002012-12-17T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency; Insured1444Ins Co - Licensed/ActiveOrganizationINDV6214MURPHY, CHRISTOPHER VERNONInsuredConversionYesFailure to Timely Respond; Referred for Disciplinary Actn2012-09-10T00:00:002012-12-17T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency; Insured659500AgentIndividualINDV6216HORDGE, CURTIS DANIEL JRInsurance CompanyMisrepresentationNoInformation Furnished2012-09-15T00:00:002012-10-04T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company; Insured1187Public Insurance AdjusterIndividualORG6218CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-20T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Self-Funded / ErisaOrganizationORGGR-Claim Evaluation6227METROPOLITAN LIFE INSURANCE COMPANYInsuredCust Service Claim HandlingNoInformation Furnished2012-09-10T00:00:002012-10-29T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life13191Ins Co - Licensed/ActiveOrganizationINDV6230BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoNo Jurisdiction2012-09-19T00:00:002012-09-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV6234TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredDelays (Policyholder Service); Refund Of PremiumYesPremium Refunded2012-08-23T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeowners1444TWIAOrganizationINDV6234HATCH, CARLTON RAYInsuredDelays (Policyholder Service); Refund Of PremiumNoInformation Furnished2012-08-23T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeowners526680AgentIndividualINDV6238UMR, INC.ProviderDenial Of Claim; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-20T00:00:002012-11-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured23490Self-Funded / ErisaOrganizationORGBUNDLING; GR-Claim Evaluation6241PRIMERICA LIFE INSURANCE COMPANYConsumer (Non-Insured)Misrepresentation; OtherNoInformation Furnished; Record Only2012-09-07T00:00:002012-12-06T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2114Ins Co - Licensed/ActiveOrganizationINDV6241SCARLETT, PAUL ANTHONYConsumer (Non-Insured)Agent HandlingYesQuestion of Fact; Record Only2012-09-07T00:00:002012-12-06T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life842661AgentIndividualINDV6242UNITEDHEALTHCARE INSURANCE COMPANYNon-Contracted ProviderDenial Of ClaimYesInformation Furnished; Additional Monies Received; No Jurisdiction2012-08-20T00:00:002012-10-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation6243AETNA LIFE INSURANCE COMPANYInsuredCust Service Claim Handling; Denial Of ClaimNoInformation Furnished; Additional Monies Received2012-09-19T00:00:002012-09-28T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV6244UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoInformation Furnished; No Jurisdiction; Contract Language/Legal Issue2012-08-20T00:00:002012-10-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation6295OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Policy Not In Force2012-09-18T00:00:002013-02-06T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE6307STATE FARM LLOYDSInsuredNon-RenewalNoCancel/Non-Renewal Upheld2012-08-23T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeownersGR Elected Official3105Ins Co - Licensed/ActiveOrganizationINDV6308LIBERTY LLOYDS OF TEXAS INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-08-22T00:00:002012-10-29T00:00:00Property and CasualtyHomeownersHomeowners11084Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6309DRIVER'S INSURANCE COMPANYConsumer (Non-Insured)Refund Of PremiumNoFailure to Timely Respond2012-09-19T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private Pass2038Ins Co - Licensed/ActiveOrganizationINDV6309LDC INSURANCE SERVICES, INC.Consumer (Non-Insured)Delays (Policyholder Service)No2012-09-19T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private Pass43215Insurance AgencyOrganizationINDV6311TEXAS FARMERS INSURANCE COMPANYInsuredNon-RenewalNo2012-09-18T00:00:002012-11-09T00:00:00Property and CasualtyHomeownersCondominiumGR Elected Official1452Ins Co - Licensed/ActiveOrganizationINDV6311FIRE INSURANCE EXCHANGEInsuredNon-RenewalNoCancel/Non-Renewal Upheld2012-09-18T00:00:002012-11-09T00:00:00Property and CasualtyHomeownersCondominiumGR Elected Official2606Ins Co - Licensed/ActiveOrganizationINDV6312STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeYesAdditional Monies Received; Information Furnished2012-08-24T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation6314STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received2012-08-24T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; DAMAGE DISPUTE; GR-Claim Evaluation6315LIBERTY INSURANCE CORPORATIONInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferNoAppraisal Process Invoked2012-08-24T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent; Insured3636Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation6316AMICA MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received2012-08-24T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured3532Ins Co - Licensed/ActiveOrganizationINDV6318SENTINEL INSURANCE COMPANY, LTD.InsuredDenial Of ClaimYesInformation Furnished; Referred for Disciplinary Actn; Additional Monies Received2012-08-24T00:00:002012-11-12T00:00:00Property and CasualtyFire, Allied Lines & CMPBusiness OwnersCorrespondent Person11174Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation6319CELTIC INSURANCE COMPANYProviderCust Service Claim Handling; Delays (Claims Handling)YesClean Claims Violation; Stat Pen Pd-Over 90 Dys Late2012-08-24T00:00:002012-12-20T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured93Ins Co - Licensed/ActiveOrganizationINDV6320MARYLAND CASUALTY COMPANYInsuredNon-RenewalYesPolicy Issued/Restored2012-08-24T00:00:002012-11-20T00:00:00Property and CasualtyFire, Allied Lines & CMPBusiness OwnersAssociated Subject Company; Correspondent Person2109Ins Co - Licensed/ActiveOrganizationORG6321OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-08-24T00:00:002012-11-02T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Person; Insured1823Ins Co - Licensed/ActiveOrganizationINDVACV; ADJUSTER'S HANDLING; GR-Claim Evaluation; TOTAL LOSS6323UNITRIN COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoAdditional Monies Received; Additional Payment Expected; Information Furnished2012-08-24T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass1856Ins Co - Licensed/ActiveOrganizationINDVACV; ADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; TOTAL LOSS6324U S LLOYDS INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld2012-08-24T00:00:002012-10-19T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person3177Ins Co - Licensed/ActiveOrganizationINDVHAIL; ROOF6325SANTA FE AUTO INSURANCE COMPANYInsuredDelays (Policyholder Service); Refund Of PremiumNoCompany Position Upheld; Information Furnished; Contract Language/Legal Issue2012-08-24T00:00:002012-12-20T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency27766Ins Co - Licensed/ActiveOrganizationINDV6326PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received2012-08-24T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVLOSS OF USE; REPLACEMENT VEHICLE6328CONTINENTAL CASUALTY COMPANYThird PartyDelays (Claims Handling)NoContract Language/Legal Issue; Information Furnished2012-08-24T00:00:002012-11-20T00:00:00Property and CasualtyMiscellaneousFidelity & SuretyAssociated Subject Company; Associated Subject Person; Correspondent Person; Insured Company2814Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING6331SAFECO INSURANCE COMPANY OF INDIANAInsuredDelays (Claims Handling); Denial Of Claim; Unsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-09-13T00:00:002013-01-25T00:00:00Property and CasualtyHomeownersHomeowners2496Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation6332DRIVER'S INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferNoClaim Settled; Additional Monies Received; Information Furnished2012-08-24T00:00:002013-01-31T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Person; Insured2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING6334STATE FARM LLOYDSInsuredDelays (Claims Handling)NoCompany Position Upheld; Additional Monies Received; Additional Payment Expected2012-08-24T00:00:002012-10-19T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person3105Ins Co - Licensed/ActiveOrganizationINDV6335UNITRIN COUNTY MUTUAL INSURANCE COMPANYInsuredCancellation; Denial Of Claim; Usual And CustomaryNoInsufficient Information2012-08-23T00:00:002012-10-26T00:00:00Property and CasualtyMiscellaneousNo Line Specified1856Ins Co - Licensed/ActiveOrganizationINDV6336FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYRelativeDenial Of ClaimNoCompany Position Upheld2012-08-24T00:00:002012-10-19T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVLOSS OF USE6337UNITEDHEALTHCARE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-20T00:00:002012-10-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationORG6338UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoInsufficient Information2012-08-20T00:00:002013-01-04T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation6339JACKSON, KIMBERLY ROCHELLInsurance CompanyAgency BalanceYesInformation Furnished2012-08-22T00:00:002012-10-23T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life982027AgentIndividualORGAGENT'S FEE6340HEALTHFIRST TPA, INC.ProviderPPACA-Out-Of-Ntwk Emerg Care; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-20T00:00:002012-10-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured44234Self-Funded / ErisaOrganizationORG6341TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Question of Fact2012-08-24T00:00:002012-11-03T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1450Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation6344UNITEDHEALTHCARE INSURANCE COMPANYContracted ProviderUnsatisfactory Settle/OfferYesClean Claims Violation; Information Furnished2012-08-20T00:00:002012-11-07T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured1348Ins Co - Licensed/ActiveOrganizationORG6345SOUTHERN COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and RatingNoInformation Furnished; Company Position Upheld2012-08-23T00:00:002012-10-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass1583Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA6347PRINCIPAL LIFE INSURANCE COMPANYContracted ProviderUnsatisfactory Settle/OfferNoInformation Furnished2012-08-20T00:00:002012-11-07T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured3032Ins Co - Licensed/ActiveOrganizationORG6348GARRISON PROPERTY AND CASUALTY INSURANCE COMPANYThird PartyDelays (Claims Handling)NoQuestion of Fact; Additional Monies Received; Information Furnished2012-08-23T00:00:002012-10-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass1697Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; UNCOOPERATIVE INSURED6349ALLSTATE INDEMNITY COMPANYThird PartyUnsatisfactory Settle/OfferNoAdditional Payment Expected2012-08-24T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured167Ins Co - Licensed/ActiveOrganizationINDV6350UMR, INC.ProviderUsual And CustomaryNoNo Jurisdiction2012-08-20T00:00:002012-10-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured23490Self-Funded / ErisaOrganizationORG6351Progressive Direct Insurance CompanyThird PartyLiability DisputeNoInformation Furnished2012-08-23T00:00:002012-11-05T00:00:00Property and CasualtyAutomobileIndividual Private Pass75983Ins Co - Licensed/ActiveOrganizationINDV6352AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-20T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Self-Funded / ErisaOrganizationORG6353PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Additional Payment Expected2012-08-24T00:00:002012-10-15T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person1708Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation6355AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-20T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Self-Funded / ErisaOrganizationORGGR-Claim Evaluation6358STATE FARM LLOYDSInsuredPremium and RatingNoCompany Position Upheld; Information Furnished2012-08-23T00:00:002012-11-02T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE6359AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-20T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Self-Funded / ErisaOrganizationORG6360ALLSTATE INSURANCE COMPANYConsumer (Non-Insured)Use of Credit ReportsNoInformation Furnished2012-08-24T00:00:002012-10-26T00:00:00Property and CasualtyMiscellaneousP & C Misc168Ins Co - Licensed/ActiveOrganizationINDVCREDIT REPORT6362BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling); Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-20T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Self-Funded / ErisaOrganizationORG6363STATE FARM LLOYDSConsumer (Non-Insured)Premium and RatingNoCompany Position Upheld; Information Furnished2012-08-23T00:00:002012-10-27T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA6364BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-20T00:00:002012-10-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Self-Funded / ErisaOrganizationORG6366BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-08-20T00:00:002012-10-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG6369HOCHHEIM PRAIRIE FARM MUTUAL INSURANCE ASSOCIATIONAgentUnsatisfactory Settle/OfferNoAdditional Monies Received; Contract Language/Legal Issue2012-08-23T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeownersInsured2350Ins Co - Licensed/ActiveOrganizationINDVAPPRAISAL; COVERAGE DISPUTE6370BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONOtherUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-08-20T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured10047Ins Co - Licensed/ActiveOrganizationORG6371STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYAttorneyUnsatisfactory Settle/OfferYesClaim Settled2012-08-23T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING6372BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction; Contract Language/Legal Issue2012-08-20T00:00:002012-11-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG6373BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-20T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Self-Funded / ErisaOrganizationORG6375GOVERNMENT EMPLOYEES HEALTH ASSOCIATION, INC.ProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-20T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured49857Self-Funded / ErisaOrganizationORG6376BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished; No Jurisdiction2012-08-20T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG6380AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-20T00:00:002012-10-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Self-Funded / ErisaOrganizationORGGR-Claim Evaluation6384COLONIAL COUNTY MUTUAL INSURANCE COMPANYInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferNoCompany Position Upheld; Information Furnished2012-08-27T00:00:002012-10-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass2455Ins Co - Licensed/ActiveOrganizationINDVAFTERMARKET PARTS; COVERAGE DISPUTE6385STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYRelativeDelays (Claims Handling)NoCompany Position Upheld2012-08-27T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDV6387ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Question of Fact2012-08-27T00:00:002012-10-13T00:00:00Property and CasualtyAutomobileIndividual Private Pass9825Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; LOSS OF USE6396PRAETORIAN INSURANCE COMPANYInsuredDenial Of ClaimYesClaim Settled; Information Furnished; Additional Monies Received2012-08-27T00:00:002012-10-22T00:00:00Life, Accident and HealthMiscellaneousP & C Misc687Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6400USAA CASUALTY INSURANCE COMPANYProviderDenial Of ClaimNoCompany Position Upheld; Information Furnished2012-08-27T00:00:002012-10-28T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured; Third Party Admin-Non Licensed3607Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation6403AMERICAN RISK INSURANCE COMPANY, INC.InsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received; Information Furnished2012-08-27T00:00:002012-10-27T00:00:00Property and CasualtyHomeownersHomeowners27377Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; WATER DAMAGE6405UNITED SERVICES AUTOMOBILE ASSOCIATIONThird PartyDelays (Claims Handling)NoCompany Position Upheld2012-08-27T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company1254Ins Co - Licensed/ActiveOrganizationINDV6408UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoInformation Furnished; Additional Monies Received2012-08-27T00:00:002012-11-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Associated Subject Person; Correspondent Person; Insured1348Ins Co - Licensed/ActiveOrganizationORG6409PACIFIC SPECIALTY PROPERTY AND CASUALTY COMPANYLienholderDelays (Claims Handling)NoAdditional Payment Expected2012-08-27T00:00:002012-10-23T00:00:00Property and CasualtyHomeownersHomeownersInsured15084Ins Co - Licensed/ActiveOrganizationINDV6410NATIONWIDE MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Liability DisputeYesAdditional Monies Received; Information Furnished2012-08-27T00:00:002012-10-28T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1937Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation6411AMERICAN ACCESS CASUALTY COMPANYThird PartyDenial Of Claim; Liability DisputeYesInformation Furnished; Entered Into Mediation; Question of Fact2012-09-17T00:00:002012-11-05T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured30332Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF; COMPARATIVE NEGLIGENCE6414BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONOtherUnsatisfactory Settle/OfferNoNo Jurisdiction; Contract Language/Legal Issue2012-08-20T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured10047Ins Co - Licensed/ActiveOrganizationORG6416PERRY, CHANCE MICHAELInsuredAgent HandlingNoOther; Information Furnished2012-08-27T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileIndividual Private Pass979806AgentIndividualINDV6418OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoAdditional Monies Received2012-08-27T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Insured1823Ins Co - Licensed/ActiveOrganizationINDV6419STAR INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferYesAdditional Payment Expected; Question of Fact; Information Furnished2012-08-24T00:00:002012-10-28T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured3526Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DIMINISHED VALUE6420GEICO INDEMNITY COMPANYInsuredDenial Of ClaimNoClaim Settled; Contract Language/Legal Issue2012-09-21T00:00:002012-12-10T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent2785Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COMPARATIVE NEGLIGENCE; MULTIPLE INSUREDS6420U S LLOYDS INSURANCE COMPANYInsuredDenial Of ClaimYesContract Language/Legal Issue; Claim Settled2012-09-21T00:00:002012-12-10T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent3177Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COMPARATIVE NEGLIGENCE; MULTIPLE INSUREDS6421SAFECO INSURANCE COMPANY OF INDIANAInsuredDelays (Claims Handling)YesAdditional Payment Expected2012-08-27T00:00:002012-10-21T00:00:00Property and CasualtyHomeownersHomeowners2496Ins Co - Licensed/ActiveOrganizationINDV6423AETNA LIFE INSURANCE COMPANYContracted ProviderUnsatisfactory Settle/OfferNoInformation Furnished2012-08-20T00:00:002012-11-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG6424LIBERTY COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received2012-08-24T00:00:002012-10-23T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured3762Ins Co - Licensed/ActiveOrganizationINDV6425MERCURY COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoInformation Furnished; Question of Fact2012-08-27T00:00:002012-10-28T00:00:00Property and CasualtyAutomobileIndividual Private Pass1693Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; DIMINISHED VALUE; GR-Claim Evaluation6427BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-08-20T00:00:002012-10-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Third Party AdministratorsOrganizationORG6430BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONPhysicianUnsatisfactory Settle/OfferNoContract Language/Legal Issue; No Jurisdiction; Information Furnished2012-08-20T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG6431NORTHLAND INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-09-20T00:00:002012-10-29T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied LinesAssociated Agent965Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation; HAIL; ROOF; UNDERWRITING CRITERIA6433The Littleton GroupInsurance CompanyDelays (Claims Handling)NoOther2012-08-27T00:00:002012-11-27T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured; Insured Company67988Third Party AdministratorsOrganizationORG6434CAPITOL COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredUnfair Discrim-Clms Handling; Unsatisfactory Settle/OfferNoAdditional Monies Received2012-09-20T00:00:002012-11-28T00:00:00Property and CasualtyHomeownersHomeowners2992Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; HAIL; ROOF6436AETNA LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-08-20T00:00:002012-10-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Self-Funded / ErisaOrganizationORGGR-Claim Evaluation6437BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoNo Jurisdiction2012-08-31T00:00:002012-09-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE6438GEICO INDEMNITY COMPANYInsuredUnfair Discrim-Clms HandlingNoQuestion of Fact; Information Furnished2012-08-27T00:00:002012-11-29T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent2785Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING6438ACEVEDO, CHRISTOPHER LUISInsuredUnfair Discrim-Clms HandlingNoQuestion of Fact2012-08-27T00:00:002012-11-29T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent875062Claims AdjusterIndividualINDVADJUSTER'S HANDLING6440UNITEDHEALTHCARE INSURANCE COMPANYPhysicianTimely Filing Deficiency; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-20T00:00:002012-10-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6442STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished; Claim Settled2012-08-27T00:00:002012-11-26T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6443DRIVER'S INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling)YesClaim Settled; Information Furnished2012-08-27T00:00:002012-11-09T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation6444PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYConsumer (Non-Insured)Denial Of Claim; Unsatisfactory Settle/OfferNoCompany Position Upheld2012-08-27T00:00:002013-03-11T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVHAIL6445UNITEDHEALTHCARE OF TEXAS, INC.ProviderDelays (Claims Handling); Timely Filing DeficiencyNoInformation Furnished; No Jurisdiction2012-08-20T00:00:002012-10-30T00:00:00Medicare HMOAccident and HealthGroup A&HAssociated Subject Company; Insured3363Health Maintenance OrgOrganizationORG6446TEXAS PIONEER TITLE AGENCYInsuredAgent HandlingYesInformation Furnished2012-08-27T00:00:002012-11-02T00:00:00Property and CasualtyMiscellaneousTitle InsuranceAssociated Subject Company74224AgentOrganizationINDV6447CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDenial Of ClaimYesAdditional Monies Received; Information Furnished2012-08-20T00:00:002012-11-06T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company; Insured2851Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6448OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYInsuredCancellation; Refund Of PremiumNoInformation Furnished2012-08-27T00:00:002012-11-07T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN6448REHMAN, AAMER AL AMINInsuredAgent HandlingNoInformation Furnished2012-08-27T00:00:002012-11-07T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency527257AgentIndividualINDVSENIOR CITIZEN6449METROPOLITAN LIFE INSURANCE COMPANYInsuredDelays (Claims Handling)NoAdditional Monies Received; Insufficient Information; Contract Language/Legal Issue2012-08-20T00:00:002012-10-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&H13191Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation6451FARMERS INSURANCE EXCHANGEConsumer (Non-Insured)Agent/Agency Contrct TerminNoInformation Furnished2012-08-27T00:00:002012-10-24T00:00:00Property and CasualtyMiscellaneousNo Line SpecifiedAssociated Agent2668Ins Co - Licensed/ActiveOrganizationINDV6451BERNSEN, JEFFERY SConsumer (Non-Insured)Agent/Agency Contrct TerminNoInformation Furnished2012-08-27T00:00:002012-10-24T00:00:00Property and CasualtyMiscellaneousNo Line SpecifiedAssociated Agent189014AgentIndividualINDV6454PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYConsumer (Non-Insured)Claimant FraudNoInsufficient Information2012-08-27T00:00:002012-11-06T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured1708Ins Co - Licensed/ActiveOrganizationINDV6460GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyDelays (Claims Handling)YesInformation Furnished; Additional Payment Expected2012-08-27T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured2486Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; SUBROGATION6461MGA INSURANCE COMPANY, INC.Consumer (Non-Insured)Denial Of ClaimNoCompany Position Upheld; Information Furnished2012-08-27T00:00:002012-11-09T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured812Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; DRIVER NOT COVERED; POLICY EXCLUSION; UNDERWRITING CRITERIA6462UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling); Timely Filing DeficiencyNoNo Jurisdiction2012-08-20T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation6463FIREMAN'S FUND INSURANCE COMPANYThird PartyDelays (Claims Handling); Denial Of Claim; Unsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld; Question of Fact2012-08-27T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2608Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; LOSS OF USE6465GRAMERCY INSURANCE COMPANYConsumer (Non-Insured)Denial Of ClaimNoCompany Position Upheld; Information Furnished2012-08-27T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured; Third Party Admin-Non Licensed1062Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation; UNCOOPERATIVE INSURED6470AAA TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredNot Within TDI JurisdictionNoInformation Furnished; No Jurisdiction2012-08-27T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company2286Ins Co - Licensed/ActiveOrganizationINDVSUBROGATION6471DELTA DENTAL OF CALIFORNIARelativeBalance Billing; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-20T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company; Insured44231Third Party AdministratorsOrganizationINDVGR-Claim Evaluation6475BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONContracted ProviderCoordination of Benefits; Delays (Claims Handling); Timely Filing DeficiencyNoNo Jurisdiction; Information Furnished2012-08-20T00:00:002012-10-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company; Insured10047Third Party AdministratorsOrganizationORGGR-Claim Evaluation6476UNDERWRITERS AT LLOYD'S, LONDONInsuredCancellationNoInformation Furnished2012-08-27T00:00:002012-11-05T00:00:00Property and CasualtyLiabilityGeneral LiabilityAssociated Subject Agency55949Ins Co - Surplus LinesOrganizationINDV6476BATTARBEE, LARRY VERNONInsuredConversion; Refund Of PremiumYesReferred for Disciplinary Actn; Failure to Timely Respond2012-08-27T00:00:002012-11-05T00:00:00Property and CasualtyLiabilityGeneral LiabilityAssociated Subject Agency529266AgentIndividualINDV6479KOCH, ADAM MICHAELInsuredDelays (Policyholder Service); Refund Of PremiumNoInformation Furnished; Premium Refunded2012-08-27T00:00:002012-10-30T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines604342AgentIndividualINDVUNDERWRITING CRITERIA6482ALLSTATE INDEMNITY COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoQuestion of Fact; Additional Monies Received; Information Furnished2012-08-27T00:00:002012-10-25T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured167Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; LOSS OF USE6483PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoAdditional Monies Received2012-08-27T00:00:002012-10-26T00:00:00Property and CasualtyAutomobileMotorcycle1708Ins Co - Licensed/ActiveOrganizationINDV6485TRAVELERS HOME AND MARINE INSURANCE COMPANY, THEInsuredIncreased Dwelling CoverageNoInformation Furnished; Company Position Upheld2012-08-27T00:00:002012-11-08T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent3875Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA6485GEICO INSURANCE AGENCY, INC.InsuredTwistingNoInformation Furnished2012-08-27T00:00:002012-11-08T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent18534AgentOrganizationINDVUNDERWRITING CRITERIA6487WELLINGTON INSURANCE COMPANYInsuredDelays (Claims Handling)NoInformation Furnished; Question of Fact2012-08-27T00:00:002012-11-02T00:00:00Property and CasualtyHomeownersHomeowners18251Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; FOUNDATION 6488PRINCIPAL LIFE INSURANCE COMPANYInsuredCash Value; Delays (Policyholder Service)NoInformation Furnished; No Jurisdiction2012-08-20T00:00:002012-11-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&H3032Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6489FIRST LIBERTY INSURANCE CORPORATION, THEThird PartyLiability DisputeNoClaim Settled; Information Furnished; Additional Monies Received2012-08-27T00:00:002012-11-09T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured3585Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COMPARATIVE NEGLIGENCE; GR-Claim Evaluation6491CONNECTICUT GENERAL LIFE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-08-20T00:00:002012-12-10T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured2851Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6492TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Question of Fact2012-08-27T00:00:002012-11-06T00:00:00Property and CasualtyHomeownersHomeowners1444TWIAOrganizationINDVDAMAGE DISPUTE; ENGINEER'S REPORT; GR-Claim Evaluation; HAIL; ROOF6493STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYInsuredCancellationNoContract Language/Legal Issue; Cancel/Non-Renewal Upheld; Information Furnished2012-08-27T00:00:002012-11-02T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA6494SENIOR INSURANCE BROKERS, LLCInsuredAgent Handling; MisrepresentationNoInformation Furnished2012-08-20T00:00:002012-12-06T00:00:00FM Fire SprinklerAccident and HealthIndividual A & H43870Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN6494OLBERDING, DEAN EInsuredImproper Inducements; MisrepresentationNoInformation Furnished2012-08-20T00:00:002012-12-06T00:00:00FM Fire SprinklerAccident and HealthIndividual A & H959149AgentIndividualINDVSENIOR CITIZEN6499WASHINGTON NATIONAL INSURANCE COMPANYInsuredCash Value; Delays (Policyholder Service); Premium NoticeNoPremium Refunded; Contract Language/Legal Issue; Information Furnished2012-08-20T00:00:002012-10-31T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company; Insured1196Ins Co - Licensed/ActiveOrganizationINDV6499GUARDIAN LIFE INSURANCE COMPANY OF AMERICA, THEInsuredCash Value; Delays (Policyholder Service); Premium NoticeNoInformation Furnished; Premium Refunded; Contract Language/Legal Issue2012-08-20T00:00:002012-10-31T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Company; Insured2414Ins Co - Licensed/ActiveOrganizationINDV6502BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONRelativeCoordination of Benefits; Cust Service Claim Handling; Non-Disclosure Of CoverageNoInformation Furnished; Contract Language/Legal Issue2012-09-24T00:00:002012-10-03T00:00:00Life, Accident and HealthAccident and HealthGroup A&HGR Elected Official; Insured; Third Party Admin-Licensed10047Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; PHARMACY; PRESCRIPTION6512INNOVATIVE RISK MANAGEMENT, INC.OtherDenial Of ClaimNoInformation Furnished2012-08-20T00:00:002012-10-30T00:00:00Property and CasualtyLiabilityGeneral Liability47466Third Party AdministratorsOrganizationINDVCOVERAGE DISPUTE6518UNITEDHEALTHCARE INSURANCE COMPANYInsuredOtherNoInformation Furnished; Contract Language/Legal Issue2012-08-21T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationORG6520SUPERIOR HEALTHPLAN NETWORKProviderDenial Of ClaimNoNo Jurisdiction2012-08-21T00:00:002012-12-18T00:00:00Health Maintenance OrgAccident and HealthIndividual A & HInsured9358Health Maintenance OrgOrganizationORGGR-Claim Evaluation6525RISK ENTERPRISE MANAGEMENT LIMITEDInjured EmployeeAccess to CareYesQuestion of Fact2012-08-07T00:00:002012-11-02T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Company; Correspondent Person185953Third Party AdministratorsOrganizationINDV6529AETNA LIFE INSURANCE COMPANYProviderDenial Of Claim; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-24T00:00:002012-10-23T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation6530AETNA LIFE INSURANCE COMPANYProviderMedical Necessity; Unsatisfactory Settle/OfferNoNo Jurisdiction2012-08-24T00:00:002012-12-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Self-Funded / ErisaOrganizationORGGR-Claim Evaluation6531AETNA LIFE INSURANCE COMPANYInsuredOtherNoNo Jurisdiction; Information Furnished2012-08-23T00:00:002012-11-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationINDV6532UNITEDHEALTHCARE INSURANCE COMPANYInsuredCoordination of Benefits; Unsatisfactory Settle/OfferYesInformation Furnished2012-08-23T00:00:002012-11-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV6532AETNA HEALTH INC.InsuredCoordination of Benefits; Unsatisfactory Settle/OfferNoInformation Furnished2012-08-23T00:00:002012-11-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&H3522Ins Co - Licensed/ActiveOrganizationINDV6533Delta Dental of CaliforniaProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-24T00:00:002012-11-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&H74255Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation6535LIFE INSURANCE COMPANY OF NORTH AMERICAInsuredDenial Of ClaimNoClaim Settled2012-08-24T00:00:002012-11-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2157Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6536UNITEDHEALTHCARE INSURANCE COMPANYInsuredDelays (Claims Handling)NoAdditional Monies Received; Information Furnished2012-08-23T00:00:002012-10-30T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1348Ins Co - Licensed/ActiveOrganizationINDV6538AETNA LIFE INSURANCE COMPANYInsuredOtherNoPolicy Issued/Restored2012-08-24T00:00:002012-11-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&HThird Party Admin-Licensed245Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE6539AETNA HEALTH INC.InsuredDelays (Claims Handling)NoNo Jurisdiction2012-08-23T00:00:002013-01-10T00:00:00Health Maintenance OrgAccident and HealthGroup A&H3522Self-Funded / ErisaOrganizationINDV6540AETNA LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction; Information Furnished2012-08-22T00:00:002012-10-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Self-Funded / ErisaOrganizationORG6541TEXAS STAR NETWORK/COVENTRYAttorneyContinuity Of Treatment; Out Of Ntwk ReferralNoInformation Furnished2012-08-22T00:00:002013-06-11T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkInjured Employee55311WC Healthcare Provider NtwkOrganizationINDV6542AMERICAN ZURICH INSURANCE COMPANYInsuredOther; Premium and RatingYesInformation Furnished; Rate Problem Resolved2012-08-28T00:00:002012-10-29T00:00:00Property and CasualtyMiscellaneousInland Marine1249Ins Co - Licensed/ActiveOrganizationORGDEDUCTIBLE; UNDERWRITING CRITERIA6543HOME STATE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoQuestion of Fact; Company Position Upheld; Information Furnished2012-08-28T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured; Third Party Admin-Licensed2362Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DIMINISHED VALUE6544HUMANA INSURANCE COMPANYInsuredDenial Of ClaimNoAdditional Monies Received; No Jurisdiction2012-08-30T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Self-Funded / ErisaOrganizationINDV6545AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-23T00:00:002012-10-26T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured245Ins Co - Licensed/ActiveOrganizationORG6546UNITEDHEALTHCARE INSURANCE COMPANYProviderDelays (Claims Handling)NoInformation Furnished2012-08-22T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV6547KATY INSURANCE AGENCY INCAgentOtherYes2012-08-28T00:00:002012-10-30T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied LinesInsured Company4768Insurance AgencyOrganizationORG6547LIME TREE UNDERWRITERS LLCAgentUnauthorized ActsNoOther2012-08-28T00:00:002012-10-30T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied LinesInsured Company36334AgentOrganizationORG6547UNDERWRITERS AT LLOYD'S, LONDONAgentOtherNoInformation Furnished2012-08-28T00:00:002012-10-30T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied LinesInsured Company55949Ins Co - Surplus LinesOrganizationORG6547CONNER, JONAS WALTERAgentOtherYes2012-08-28T00:00:002012-10-30T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied LinesInsured Company57975AgentIndividualORG6549FOREMOST COUNTY MUTUAL INSURANCE COMPANYInsuredCust Service Claim Handling; Denial Of ClaimNoAdditional Monies Received; Question of Fact; Information Furnished2012-08-29T00:00:002012-11-08T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person2530Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; BURDEN OF PROOF; DAMAGE DISPUTE; HAIL; ROOF; UNDERWRITING CRITERIA6551LIFE INSURANCE COMPANY OF THE SOUTHWESTInsuredDelays (Policyholder Service)NoContract Language/Legal Issue; Information Furnished2012-08-22T00:00:002012-10-31T00:00:00Life, Accident and HealthLife & AnnuityIRA 2158Ins Co - Licensed/ActiveOrganizationINDV6552GERMANIA FIRE & CASUALTY COMPANYInsuredDelays (Policyholder Service)NoContract Language/Legal Issue; Information Furnished; Company Position Upheld2012-08-29T00:00:002012-11-16T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency3298Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA6553PRUDENTIAL INSURANCE COMPANY OF AMERICA, THEInsuredDenial Of ClaimNoNo Jurisdiction2012-08-21T00:00:002012-12-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1729Ins Co - Licensed/ActiveOrganizationINDV6554BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-08-27T00:00:002012-11-03T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationINDV6556NATIONAL LIABILITY & FIRE INSURANCE COMPANYInsuredCancellationNoCancel/Non-Renewal Upheld; Information Furnished2012-08-27T00:00:002012-11-15T00:00:00Property and CasualtyAutomobileBusiness AutomobileAssociated Subject Agency; Associated Subject Company; Associated Subject Person737Ins Co - Licensed/ActiveOrganizationORG6556KIELY HINES & ASSOC INS AGENCY INCInsuredAgent HandlingNoInformation Furnished2012-08-27T00:00:002012-11-15T00:00:00Property and CasualtyAutomobileBusiness AutomobileAssociated Subject Agency; Associated Subject Company; Associated Subject Person21867Insurance AgencyOrganizationORG6557UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-08-22T00:00:002012-11-06T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HCorrespondent Person; Insured1348Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN6558CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-23T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Self-Funded / ErisaOrganizationORGGR-Claim Evaluation6559LINCOLN LIFE & ANNUITY COMPANY OF NEW YORKRelativeCash Value; Delays (Claims Handling); Delays In Authorization; Denial Of ClaimNoCash Surrender Paid2012-08-30T00:00:002012-10-19T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeAssociated Subject Person; Deceased Person2905Ins Co - Licensed/ActiveOrganizationINDV6560BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoNo Jurisdiction2012-08-27T00:00:002012-10-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Self-Funded / ErisaOrganizationINDV6561GRAMERCY INSURANCE COMPANYThird PartyDelays (Claims Handling)No2012-08-23T00:00:002012-11-05T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Third Party Admin-Non Licensed1062Ins Co - Licensed/ActiveOrganizationINDV6563MERCURY COUNTY MUTUAL INSURANCE COMPANYRelativeCust Service Claim Handling; Delays (Claims Handling); Denial Of ClaimNoContract Language/Legal Issue; Question of Fact; Information Furnished2012-08-29T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1693Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF6564IBARRA, MARIBELInsuredPremium and RatingNoInformation Furnished2012-09-24T00:00:002012-11-28T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Insured981426AgentIndividualINDVSENIOR CITIZEN; UNDERWRITING CRITERIA6565CVS CaremarkInsuredDelays (Claims Handling)NoNo Jurisdiction2012-08-24T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured66053ProviderOrganizationINDV6566LOYA INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferYesAdditional Monies Received; Information Furnished; Question of Fact2012-08-24T00:00:002012-11-26T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured15643Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation; LOSS OF USE; SUPPLEMENTARY PAYMENT6567TEXAS HEALTH INSURANCE POOLProviderDelays (Claims Handling)NoInformation Furnished2012-08-23T00:00:002012-11-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured9031Ins Co - Licensed/ActiveOrganizationORG6567BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoInformation Furnished2012-08-23T00:00:002012-11-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG6568BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of Claim; Medical NecessityNoNo Jurisdiction2012-08-27T00:00:002012-10-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV6569TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferNoQuestion of Fact; Contract Language/Legal Issue; Information Furnished2012-08-30T00:00:002012-11-06T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1450Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF; DAMAGE DISPUTE; DIMINISHED VALUE; LOSS OF USE; TOTAL LOSS6570CONSECO LIFE INSURANCE COMPANYInsuredPremium NoticeNoContract Language/Legal Issue; Information Furnished2012-08-29T00:00:002012-11-05T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2113Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN6571UNITEDHEALTHCARE INSURANCE COMPANYAttorneyDenial Of ClaimNoContract Language/Legal Issue2012-08-30T00:00:002012-11-26T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG6573DRIVER'S INSURANCE COMPANYInsuredCust Service Claim HandlingNoCompany Position Upheld; Information Furnished2012-08-27T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass2038Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED6574OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyCust Service Claim Handling; Denial Of ClaimNoInformation Furnished; Company Position Upheld2012-08-24T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured; Third Party Admin-Non Licensed1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; LOSS OF USE; POLICY EXCLUSION; UNCOOPERATIVE INSURED6576AETNA LIFE INSURANCE COMPANYInsuredDenial Of ClaimNoNo Jurisdiction2012-08-24T00:00:002012-11-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationINDV6577STATE FARM LIFE INSURANCE COMPANYInsuredOtherNoInformation Furnished; Contract Language/Legal Issue2012-08-27T00:00:002012-10-31T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1509Ins Co - Licensed/ActiveOrganizationINDV6577STURM, JULIE ARLAYNEInsuredAgent HandlingNoInformation Furnished2012-08-27T00:00:002012-10-31T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life37396AgentIndividualINDV6578BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONRelativeDenial Of ClaimNoNo Jurisdiction2012-08-27T00:00:002012-11-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV6579HUMANA INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-08-30T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationORG6581ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferYesInformation Furnished; Claim Settled2012-08-31T00:00:002012-10-30T00:00:00Property and CasualtyHomeownersHomeownersInsured936Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; HAIL; ROOF6582UNITEDHEALTHCARE INSURANCE COMPANYInsuredDenial Of ClaimYesContract Language/Legal Issue; Insufficient Information2012-08-30T00:00:002012-11-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationINDV6583NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA.InsuredDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-08-31T00:00:002012-11-08T00:00:00Property and CasualtyMiscellaneousTravel1931Ins Co - Licensed/ActiveOrganizationINDV6584DELTA DENTAL INSURANCE COMPANYProviderRecoupment Of Claims PaymentNoAdditional Monies Received; Information Furnished2012-08-22T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInjured Employee2752Ins Co - Licensed/ActiveOrganizationORG6585CONNECTICUT GENERAL LIFE INSURANCE COMPANYInsuredDelays (Claims Handling)NoInsufficient Information2012-08-20T00:00:002012-11-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN6587AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling); Denial Of ClaimNoNo Jurisdiction2012-08-24T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Self-Funded / ErisaOrganizationORG6588BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONNon-Contracted ProviderUnsatisfactory Settle/Offer; Usual And CustomaryNoInformation Furnished2012-08-24T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company; Insured10047Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation6589DRIVER'S INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-08-31T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency2038Ins Co - Licensed/ActiveOrganizationINDVUNCOOPERATIVE INSURED6590BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling); Unsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-08-22T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORGGRANDFATHERED HEALTH PLAN6591HOME STATE COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoInsufficient Information; Contract Language/Legal Issue2012-08-31T00:00:002012-11-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass2362Ins Co - Licensed/ActiveOrganizationINDV6592BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONNon-Contracted ProviderSB418 Rule Violation; Unsatisfactory Settle/Offer; Usual And CustomaryNoNo Jurisdiction; Additional Monies Received2012-08-23T00:00:002012-10-30T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured; Third Party Admin-Licensed10047Self-Funded / ErisaOrganizationORG6593AMERIGROUP TEXAS, INC.Contracted ProviderNot Within TDI JurisdictionNoRecord Only2012-08-29T00:00:002012-12-10T00:00:00Health Maintenance OrgAccident and HealthGroup A&HCorrespondent Person; Insured8032Health Maintenance OrgOrganizationORG6594STANDARD LIFE AND CASUALTY INSURANCE COMPANYInsuredRefund Of PremiumYesPremium Refunded2012-08-30T00:00:002013-01-14T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Agent105Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE6595ALLSTATE INDEMNITY COMPANYInsuredPremium and Rating; Refund Of PremiumNoCompany Position Upheld; Insufficient Information2012-08-27T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass167Ins Co - Licensed/ActiveOrganizationINDV6596INFINITY COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Denial Of ClaimNoAdditional Monies Received; Company Position Upheld; Information Furnished2012-08-24T00:00:002013-01-29T00:00:00Property and CasualtyAutomobileIndividual Private Pass1197Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation6597PHYSICIANS HEALTH CHOICE OF TEXAS, LLCHospitalDelays (Claims Handling)NoNo Jurisdiction2012-08-23T00:00:002012-12-12T00:00:00Medicare HMOAccident and HealthIndividual A & H17170Health Maintenance OrgOrganizationORGSENIOR CITIZEN6598TEXAS FARM BUREAU CASUALTY INSURANCE COMPANYThird PartyDenial Of ClaimNoContract Language/Legal Issue; Claim Settled2012-08-31T00:00:002012-11-14T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured28440Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; UNCOOPERATIVE INSURED6599HUMANA INSURANCE COMPANYProviderDenial Of ClaimNoAdditional Monies Received2012-08-27T00:00:002012-10-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person; Insured1040Ins Co - Licensed/ActiveOrganizationORG6600FIDELITY NATIONAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Additional Payment Expected2012-08-29T00:00:002012-11-14T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person17916Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF6601SENIOR LIFE INSURANCE COMPANYRelativeDenial Of ClaimNoContract Language/Legal Issue; Information Furnished2012-08-20T00:00:002012-11-01T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeDeceased Person; Third Party Admin-Non Licensed16102Ins Co - Licensed/ActiveOrganizationINDVRESCISSION; SENIOR CITIZEN6602CIGNA HEALTH AND LIFE INSURANCE COMPANYProviderDenial Of ClaimNoNo Jurisdiction2012-08-24T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1841Self-Funded / ErisaOrganizationORG6603PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)NoOther2012-09-04T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDV6605HOME STATE COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeNoQuestion of Fact; Information Furnished; Contract Language/Legal Issue2012-08-29T00:00:002012-11-16T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company; Correspondent Person2362Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; BURDEN OF PROOF; GR-Claim Evaluation6606WELLCARE OF TEXAS, INC.InsuredDenial Of ClaimNoNo Jurisdiction2012-08-22T00:00:002012-12-17T00:00:00Medicare HMOAccident and HealthIndividual A & H28079Health Maintenance OrgOrganizationINDVSENIOR CITIZEN6608ACCC INSURANCE COMPANYThird PartyDelays (Claims Handling)NoContract Language/Legal Issue; Information Furnished2012-08-31T00:00:002012-11-05T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured9825Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; NAMED DRIVER POLICY6609PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoQuestion of Fact; Information Furnished2012-08-30T00:00:002012-12-11T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured1708Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF6610AETNA LIFE INSURANCE COMPANYProviderDenial Of Claim; PPACA-Out-Of-Ntwk Emerg CareNoNo Jurisdiction2012-08-24T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company; Insured245Self-Funded / ErisaOrganizationORG6611JIVAR FOTY AGENCY LLCAgentOtherNoInsufficient Information2012-08-23T00:00:002012-10-10T00:00:00Property and CasualtyMiscellaneousP & C Misc35048AgentOrganizationINDV6612AMERICAN GENERAL LIFE INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-08-29T00:00:002012-11-06T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life152Ins Co - Licensed/ActiveOrganizationINDV6613PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Corrective Action Taken2012-08-30T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DRIVER NOT COVERED; UNDERWRITING CRITERIA6614RADIAN GUARANTY INC.AttorneyCancellation; Delays (Underwriting); Non-RenewalNoCompany Position Upheld; Question of Fact; Information Furnished2012-08-23T00:00:002012-12-19T00:00:00Property and CasualtyMiscellaneousMortgage Guaranty2837Ins Co - Licensed/ActiveOrganizationINDVUNDERWRITING CRITERIA6615OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoQuestion of Fact; Information Furnished2012-08-31T00:00:002012-11-26T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Person1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation; UNCOOPERATIVE INSURED6616STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYRelativeDelays (Claims Handling)NoInformation Furnished2012-09-04T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1510Ins Co - Licensed/ActiveOrganizationINDV6617PROPERTY AND CASUALTY INSURANCE COMPANY OF HARTFORDInsuredDenial Of ClaimNoQuestion of Fact; Information Furnished; Contract Language/Legal Issue2012-08-30T00:00:002012-11-16T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency; Associated Subject Company; Associated Subject Person8123Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; DAMAGE DISPUTE; HAIL; ROOF; UNCOOPERATIVE INSURED6618HUMANA HEALTH PLAN OF TEXAS, INC.Non-Contracted ProviderUnsatisfactory Settle/OfferYesInformation Furnished2012-08-22T00:00:002012-11-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured702Ins Co - Licensed/ActiveOrganizationORGEMERGENCY CARE6618HUMANA INSURANCE COMPANYNon-Contracted ProviderUnsatisfactory Settle/OfferYesClean Claims Violation; Information Furnished; Corrective Action Taken2012-08-22T00:00:002012-11-12T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORGEMERGENCY CARE6619BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDenial Of ClaimNoInformation Furnished; No Jurisdiction2012-08-24T00:00:002012-11-05T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company; Correspondent Person; Insured10047Ins Co - Licensed/ActiveOrganizationORGPHARMACY; PRESCRIPTION6621FREEDOM LIFE INSURANCE COMPANY OF AMERICAContracted ProviderUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-08-24T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company; Insured2855Ins Co - Licensed/ActiveOrganizationORG6622GREAT AMERICAN INSURANCE COMPANYAttorneyPremium and RatingNoCorrective Action Taken2012-09-05T00:00:002012-11-30T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines2437Ins Co - Licensed/ActiveOrganizationINDV6622BERKADIA COMMERCIAL MORTGAGE LLCAttorneyOtherNoOther2012-09-05T00:00:002012-11-30T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied Lines74282Mortgage LenderOrganizationINDV6623AMERICAN MODERN HOME INSURANCE COMPANYLienholderCancellation; Endorsement / RiderNoContract Language/Legal Issue; Company Position Upheld2012-08-30T00:00:002012-11-27T00:00:00Property and CasualtyHomeownersHomeowners231Ins Co - Licensed/ActiveOrganizationINDV6624NATIONWIDE PROPERTY AND CASUALTY INSURANCE COMPANYInsuredCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferNoContract Language/Legal Issue; Company Position Upheld; Information Furnished2012-08-30T00:00:002013-01-24T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person3165Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; BURDEN OF PROOF; DAMAGE DISPUTE; DEDUCTIBLE; HAIL; ROOF; WATER DAMAGE6625CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-09-25T00:00:002012-11-07T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured2851Self-Funded / ErisaOrganizationORG6626GLOBE LIFE AND ACCIDENT INSURANCE COMPANYInsuredOtherNoInformation Furnished; Contract Language/Legal Issue2012-08-21T00:00:002012-11-01T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life917Ins Co - Licensed/ActiveOrganizationINDV6627STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoInformation Furnished; Additional Monies Received; Claim Settled2012-08-30T00:00:002012-11-06T00:00:00Property and CasualtyAutomobileIndividual Private Pass1510Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; LOSS OF USE; TOTAL LOSS6628GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredDenial Of ClaimYesClaim Settled; Information Furnished2012-08-31T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent2486Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING6629AMERIGROUP TEXAS, INC.InsuredDenial Of ClaimNoContract Language/Legal Issue2012-08-23T00:00:002012-12-18T00:00:00Health Maintenance OrgAccident and HealthIndividual A & HInsured8032Health Maintenance OrgOrganizationINDV6630BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONOtherDenial Of ClaimNoNo Jurisdiction2012-08-24T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Company; Insured10047Self-Funded / ErisaOrganizationORG6632COMBINED INSURANCE COMPANY OF AMERICAInsuredDelays (Claims Handling)NoPremium Refunded2012-08-30T00:00:002012-11-09T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H2863Ins Co - Licensed/ActiveOrganizationINDV6632PARKER, GEOFFREY RICHARDInsuredMisrepresentationNoQuestion of Fact2012-08-30T00:00:002012-11-09T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H790377AgentIndividualINDV6635DAIRYLAND COUNTY MUTUAL INSURANCE COMPANY OF TEXASThird PartyDelays (Claims Handling)NoClaim Settled2012-09-04T00:00:002012-11-08T00:00:00Property and CasualtyAutomobileIndividual Private Pass2737Ins Co - Licensed/ActiveOrganizationORG6636AMERICA FIRST LLOYD'S INSURANCE COMPANYAttorneyDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-08-28T00:00:002012-12-27T00:00:00Property and CasualtyFire, Allied Lines & CMPBusiness OwnersInsured Company17819Ins Co - Licensed/ActiveOrganizationORGCOVERAGE DISPUTE6637BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDelays (Claims Handling)NoNo Jurisdiction2012-08-29T00:00:002012-10-15T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Self-Funded / ErisaOrganizationINDV6638TEXAS WINDSTORM INSURANCE ASSOCIATIONOtherDelays (Claims Handling)NoClaim Settled; Additional Monies Received2012-08-30T00:00:002012-11-14T00:00:00Property and CasualtyHomeownersHomeownersCorrespondent Person; Insured1444TWIAOrganizationORGDEPRECIATION6639HUMANA HEALTH PLAN OF TEXAS, INC.ProviderDenial Of ClaimYesAdditional Monies Received2012-08-24T00:00:002012-10-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured702Ins Co - Licensed/ActiveOrganizationORG6640Global Insurance ServicesConsumer (Non-Insured)Improper InducementsNoInsufficient Information; Information Furnished; Question of Fact2012-08-31T00:00:002013-03-11T00:00:00Property and CasualtyMiscellaneousWatercraftAssociated Subject Person80185Insurance AgencyOrganizationINDV6641FIRST MERCURY INSURANCE COMPANYInsuredCust Service Claim Handling; Liability DisputeNoContract Language/Legal Issue2012-08-31T00:00:002013-01-14T00:00:00Property and CasualtyLiabilityGeneral LiabilityAssociated Agent48535Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE6642AETNA HEALTH INC.Non-Contracted ProviderUnsatisfactory Settle/Offer; Usual And CustomaryNoContract Language/Legal Issue2012-08-29T00:00:002012-10-31T00:00:00Health Maintenance OrgAccident and HealthGroup A&H3522Health Maintenance OrgOrganizationORG6643AETNA LIFE INSURANCE COMPANYContracted ProviderUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-08-24T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation6644ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredCust Service Claim Handling; Premium and RatingNoInformation Furnished2012-09-04T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDV6646DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling)YesInformation Furnished; Additional Monies Received; Corrective Action Taken2012-08-30T00:00:002012-11-09T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured2038Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; TOTAL LOSS; UNCOOPERATIVE INSURED6647UNITEDHEALTHCARE INSURANCE COMPANYInsuredOtherNoNo Jurisdiction2012-08-29T00:00:002012-10-17T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Self-Funded / ErisaOrganizationINDV6648AETNA LIFE INSURANCE COMPANYContracted ProviderDenial Of Claim; SB418 Rule ViolationYesAdditional Monies Received; Stat Pen Pd-46 To 90 Dys Late2012-09-25T00:00:002012-11-07T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured245Health Maintenance OrgOrganizationINDV6649HUMANA INSURANCE COMPANYInsuredDenial Of ClaimYesInformation Furnished2012-08-20T00:00:002012-11-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6650FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received2012-08-31T00:00:002012-11-18T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; COVERAGE DISPUTE; GR-Claim Evaluation6651NATIONWIDE MUTUAL INSURANCE COMPANYInsuredOtherNoContract Language/Legal Issue2012-09-04T00:00:002013-01-04T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency1937Ins Co - Licensed/ActiveOrganizationINDV6652QUINN, OLGA LYDIAAgentConversionYesReferred for Disciplinary Actn2012-08-28T00:00:002012-12-06T00:00:00Property and CasualtyAutomobileIndividual Private Pass769948AgentIndividualINDV6653METROPOLITAN LLOYDS INSURANCE COMPANY OF TEXASThird PartyDelays (Claims Handling)NoInformation Furnished2012-08-31T00:00:002012-11-05T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured3848Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6654AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-24T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Self-Funded / ErisaOrganizationORGGR-Claim Evaluation6656FOREMOST COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoClaim Settled2012-09-04T00:00:002012-10-30T00:00:00Property and CasualtyHomeownersHomeowners2530Ins Co - Licensed/ActiveOrganizationINDV6657INFINITY COUNTY MUTUAL INSURANCE COMPANYInsuredDelays (Claims Handling)NoContract Language/Legal Issue2012-08-31T00:00:002012-12-05T00:00:00Property and CasualtyAutomobileIndividual Private Pass1197Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; DRIVER NOT COVERED6659GEOVERA SPECIALTY INSURANCE COMPANYInsuredDenial Of ClaimNoContract Language/Legal Issue; Company Position Upheld2012-09-04T00:00:002012-11-26T00:00:00Property and CasualtyHomeownersHomeowners56985Ins Co - Surplus LinesOrganizationINDVGR-Claim Evaluation; POLICY EXCLUSION6661FIRSTCARE HEALTH PLANSProviderDenial Of ClaimNoNo Jurisdiction2012-08-24T00:00:002012-12-14T00:00:00Health Maintenance OrgAccident and HealthIndividual A & HInsured71287OtherOrganizationORGGR-Claim Evaluation6663HORACE MANN INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferYesInformation Furnished; Additional Monies Received; Claim Settled2012-08-28T00:00:002012-11-06T00:00:00Property and CasualtyAutomobileIndividual Private Pass2366Ins Co - Licensed/ActiveOrganizationORGCOMPARATIVE NEGLIGENCE6664UNITED SERVICES AUTOMOBILE ASSOCIATIONInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-08-31T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass1254Ins Co - Licensed/ActiveOrganizationINDV6665CONNECTICUT GENERAL LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-24T00:00:002012-11-13T00:00:00Life, Accident and HealthAccident and HealthGroup A&H2851Self-Funded / ErisaOrganizationORG6667METROPOLITAN LIFE INSURANCE COMPANYInsuredPremium and RatingNoNo Jurisdiction; Contract Language/Legal Issue2012-08-29T00:00:002012-11-26T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H13191Ins Co - Licensed/ActiveOrganizationINDV6668BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of ClaimNoNo Jurisdiction2012-08-30T00:00:002012-11-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Self-Funded / ErisaOrganizationINDV6669HUMANA INSURANCE COMPANYProviderRecoupment Of Claims PaymentYesAdditional Payment Expected2012-09-25T00:00:002012-10-29T00:00:00Health Maintenance OrgAccident and HealthIndividual A & HInsured1040Ins Co - Licensed/ActiveOrganizationORG6670SELECTCARE OF TEXAS, L.L.C.InsuredDelays (Claims Handling)NoNo Jurisdiction2012-08-22T00:00:002013-02-06T00:00:00Medicare HMOAccident and HealthIndividual A & H14275Health Maintenance OrgOrganizationINDVSENIOR CITIZEN6672AETNA LIFE INSURANCE COMPANYInsuredDelays (Claims Handling)NoNo Jurisdiction2012-08-28T00:00:002012-10-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Self-Funded / ErisaOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation6673JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.)InsuredPremium and RatingNoInformation Furnished; Contract Language/Legal Issue2012-09-04T00:00:002012-11-26T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1148Ins Co - Licensed/ActiveOrganizationINDV6674LIFESECURE INSURANCE COMPANYRelativePremium and RatingYesRate Problem Resolved2012-08-27T00:00:002012-10-31T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1385Ins Co - Licensed/ActiveOrganizationINDV6675RXMEDCOConsumer (Non-Insured)Not Within TDI JurisdictionNoNo Jurisdiction2012-08-30T00:00:002012-12-20T00:00:00Property and CasualtyMiscellaneousP & C Misc74294WC Healthcare Provider NtwkOrganizationORG6676UNIVERSAL NORTH AMERICA INSURANCE COMPANYInsuredDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received; Claim Settled; Appraisal Process Invoked2012-08-27T00:00:002013-01-14T00:00:00Property and CasualtyHomeownersHomeowners23526Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; EXAM UNDER OATH; GR-Claim Evaluation; WATER DAMAGE6678AMERICAN RISK INSURANCE COMPANY, INC.InsuredDelays (Claims Handling)YesClaim Settled; Information Furnished2012-08-30T00:00:002012-10-29T00:00:00Property and CasualtyHomeownersHomeowners27377Ins Co - Licensed/ActiveOrganizationINDVHAIL; ROOF6679AETNA LIFE INSURANCE COMPANYProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-22T00:00:002012-11-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Self-Funded / ErisaOrganizationORG6680ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeNoQuestion of Fact; Information Furnished2012-08-29T00:00:002012-11-01T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent; Insured936Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; BURDEN OF PROOF6683BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferYesAdditional Monies Received2012-08-24T00:00:002013-01-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationORG6685SAFECO INSURANCE COMPANY OF INDIANAInsuredDelays (Claims Handling); Denial Of ClaimNoInformation Furnished; Contract Language/Legal Issue; Question of Fact2012-08-30T00:00:002012-11-07T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person2496Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; APPRAISAL; BURDEN OF PROOF; DAMAGE DISPUTE; MOLD; ROOF; UNDERWRITING CRITERIA; WATER DAMAGE6686AETNA LIFE INSURANCE COMPANYPhysicianUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-30T00:00:002012-12-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Self-Funded / ErisaOrganizationINDV6687ALLSTATE TEXAS LLOYD'SInsuredUnsatisfactory Settle/OfferNoAdditional Monies Received; Question of Fact; Information Furnished2012-08-27T00:00:002012-10-29T00:00:00Property and CasualtyHomeownersHomeowners3721Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF; DAMAGE DISPUTE; HAIL; ROOF; SENIOR CITIZEN6688EDDIE VITALE AGENCY, L.L.C.InsuredAgent HandlingYesInformation Furnished2012-09-04T00:00:002012-11-07T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency35993Insurance AgencyOrganizationINDV6688CATLIN INSURANCE COMPANY (UK) LTD.InsuredCancellationNoInformation Furnished; Cancel/Non-Renewal Upheld2012-09-04T00:00:002012-11-07T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency54370Ins Co - Surplus LinesOrganizationINDV6689PRIMERICA LIFE INSURANCE COMPANYInsuredDelays (Policyholder Service)NoInformation Furnished; Contract Language/Legal Issue2012-08-22T00:00:002012-11-01T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2114Ins Co - Licensed/ActiveOrganizationINDV6690INFINITY COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimNoContract Language/Legal Issue2012-09-03T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1197Ins Co - Licensed/ActiveOrganizationINDV6691OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDenial Of ClaimNoCompany Position Upheld2012-08-27T00:00:002012-10-24T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6692DRIVER'S INSURANCE COMPANYThird PartyDelays (Claims Handling)NoAdditional Monies Received; Information Furnished; Claim Settled2012-08-29T00:00:002012-12-31T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Person; Insured2038Ins Co - Licensed/ActiveOrganizationINDVDIMINISHED VALUE; LOSS OF USE6693NORTHWESTERN MUTUAL LIFE INSURANCE COMPANY, THEInsuredOtherNoCompany Position Upheld2012-08-29T00:00:002012-10-31T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1859Ins Co - Licensed/ActiveOrganizationINDV6694JOHN HANCOCK LIFE & HEALTH INSURANCE COMPANYBeneficiaryCash Value; Unsatisfactory Settle/OfferNoCompany Position Upheld2012-08-28T00:00:002012-11-01T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HDeceased Person632Ins Co - Licensed/ActiveOrganizationINDV6695OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDenial Of ClaimNoQuestion of Fact; Information Furnished2012-08-28T00:00:002012-11-08T00:00:00Property and CasualtyAutomobileIndividual Private Pass1823Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6696NEW BENEFITS, LTD.Consumer (Non-Insured)Misleading AdvertisingNoInformation Furnished2012-08-31T00:00:002012-11-26T00:00:00Life, Accident and HealthAccident and HealthDiscount Health Care ProgramAssociated Subject Company37475AgentOrganizationINDVADVERTISING6696HB Innovative Market Solutions, IncConsumer (Non-Insured)Misleading AdvertisingNo2012-08-31T00:00:002012-11-26T00:00:00Life, Accident and HealthAccident and HealthDiscount Health Care ProgramAssociated Subject Company76263OtherOrganizationINDVADVERTISING6697LINCOLN BENEFIT LIFE COMPANYInsuredAgent HandlingNoInformation Furnished; Contract Language/Legal Issue2012-08-23T00:00:002012-11-02T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life2168Ins Co - Licensed/ActiveOrganizationINDV6698REASSURE AMERICA LIFE INSURANCE COMPANYInsuredPremium and RatingNoCompany Position Upheld2012-08-22T00:00:002012-11-02T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1228Ins Co - Licensed/ActiveOrganizationINDV6699SANTA FE AUTO INSURANCE COMPANYInsuredDelays (Claims Handling)NoCompany Position Upheld; Claim Settled; Information Furnished2012-09-04T00:00:002012-11-06T00:00:00Property and CasualtyAutomobileIndividual Private Pass27766Ins Co - Licensed/ActiveOrganizationINDVTOTAL LOSS6700BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue; Information Furnished2012-08-24T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV6701METROPOLITAN LIFE INSURANCE COMPANYContracted ProviderDenial Of ClaimNoContract Language/Legal Issue2012-08-31T00:00:002012-12-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&H13191Ins Co - Licensed/ActiveOrganizationORG6702PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYProviderUnsatisfactory Settle/OfferYesInformation Furnished; Claim Settled; Additional Monies Received2012-08-30T00:00:002012-10-27T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING6703INTEGON NATIONAL INSURANCE COMPANYLienholderDenial Of ClaimNoInformation Furnished; Additional Monies Received2012-08-28T00:00:002012-11-07T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured3644Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation6704AMERICAN NATIONAL LLOYDS INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld; Additional Payment Expected2012-09-04T00:00:002012-11-07T00:00:00Property and CasualtyHomeownersHomeowners7613Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF6705NORTHEAST TEXAS INSURANCE GROUP LTD LLPInsuredAgent HandlingNoInformation Furnished; Company Position Upheld2012-08-29T00:00:002012-11-02T00:00:00Property and CasualtyFire, Allied Lines & CMPCommercial Fire & Allied LinesAssociated Subject Company; Associated Subject Person; Insured9240AgentOrganizationINDV6706DAIRYLAND COUNTY MUTUAL INSURANCE COMPANY OF TEXASInsuredDenial Of ClaimNoInformation Furnished; Company Position Upheld2012-08-27T00:00:002012-10-22T00:00:00Property and CasualtyAutomobileMotorcycle2737Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNDERWRITING CRITERIA6707ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredPremium and RatingYesAdditional Monies Received2012-09-04T00:00:002012-11-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING6709GOVERNMENT EMPLOYEES INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Payment Expected2012-09-04T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDV6710BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredRefusal to InsureNoPolicy Issued/Restored2012-08-22T00:00:002012-10-18T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationINDV6711STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXASProviderAssignment of BenefitsNoInformation Furnished; Contract Language/Legal Issue2012-08-30T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Person; Insured1506Ins Co - Licensed/ActiveOrganizationORGCHIROPRACTIC6712OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received; Information Furnished; Claim Settled2012-08-27T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Insured1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; DAMAGE DISPUTE; GR-Claim Evaluation; TOTAL LOSS6713FORTE, INC. / COMPKEY PLUSContracted ProviderDenial Of ClaimNoContract Language/Legal Issue2012-08-22T00:00:002012-11-08T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkInjured Employee; Third Party Admin-Licensed53636WC Healthcare Provider NtwkOrganizationORG6714BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONOtherUnsatisfactory Settle/OfferNoNo Jurisdiction2012-09-25T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Self-Funded / ErisaOrganizationORG6715UNITEDHEALTHCARE INSURANCE COMPANYEmployerOtherNoInformation Furnished; Contract Language/Legal Issue2012-08-24T00:00:002012-10-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Ins Co - Licensed/ActiveOrganizationORG6716PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYOtherCust Service Claim Handling; Unsatisfactory Settle/OfferNoAdditional Monies Received; Information Furnished2012-09-04T00:00:002012-11-07T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured1708Ins Co - Licensed/ActiveOrganizationORGADJUSTER'S HANDLING; AFTERMARKET PARTS; DAMAGE DISPUTE; GR-Claim Evaluation6717SIG INSURANCE SERVICES, L.L.C.InsuredDelays (Policyholder Service)NoInformation Furnished2012-08-30T00:00:002013-01-11T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent; Associated Subject Company21024AgentOrganizationINDV6717ARNOLD, KIM LEEInsuredAgent Handling; Conversion; MisrepresentationYesNo Enforcement Case Opened; Failure to Timely Respond; Referred for Disciplinary Actn2012-08-30T00:00:002013-01-11T00:00:00Property and CasualtyHomeownersHomeownersAssociated Agent; Associated Subject Company848944AgentIndividualINDV6718BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling); Unsatisfactory Settle/OfferNoNo Jurisdiction2012-09-25T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HInsured10047Self-Funded / ErisaOrganizationORG6719SOUTHERN COUNTY MUTUAL INSURANCE COMPANYThird PartyCust Service Claim Handling; Delays (Claims Handling)NoClaim Settled2012-08-28T00:00:002012-11-08T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Correspondent Person1583Ins Co - Licensed/ActiveOrganizationORGSUBROGATION6720UNITEDHEALTHCARE INSURANCE COMPANYInsuredDelays (Claims Handling)NoNo Jurisdiction2012-08-28T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Self-Funded / ErisaOrganizationINDVCOVERAGE DISPUTE; GR-Claim Evaluation6722UNITED FINANCIAL CASUALTY COMPANYInsuredDenial Of ClaimNoInsufficient Information2012-09-04T00:00:002012-11-25T00:00:00Property and CasualtyMiscellaneousP & C Misc3383Ins Co - Licensed/ActiveOrganizationINDV6723CERIDIAN BENEFITS SERVICES, INC.InsuredPremium NoticeNoCancellation Withdrawn; Policy Issued/Restored; No Jurisdiction2012-08-23T00:00:002012-12-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&H47849Govermental EntityOrganizationINDV6724ALLSTATE TEXAS LLOYD'SInsuredCust Service Claim Handling; Delays (Claims Handling); Unsatisfactory Settle/OfferNoAdditional Monies Received; Claim Settled; Information Furnished2012-08-30T00:00:002012-10-30T00:00:00Property and CasualtyHomeownersHomeowners3721Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; SUPPLEMENTARY PAYMENT; UNDERWRITING CRITERIA6725STATE FARM LLOYDSInsuredRefund Of PremiumNoAdditional Monies Received; Information Furnished; Premium Refunded2012-08-27T00:00:002012-10-29T00:00:00Property and CasualtyHomeownersRentalInsured3105Ins Co - Licensed/ActiveOrganizationINDV6725STEWART, THOMAS WILLIAMInsuredAgent HandlingYes2012-08-27T00:00:002012-10-29T00:00:00Property and CasualtyHomeownersRentalInsured24532AgentIndividualINDV6727UNITEDHEALTHCARE INSURANCE COMPANYProviderDenial Of ClaimNoInformation Furnished2012-08-24T00:00:002012-11-02T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationORG6728UNITEDHEALTHCARE INSURANCE COMPANYInsuredOverchargesNoNo Jurisdiction2012-08-24T00:00:002012-10-25T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1348Self-Funded / ErisaOrganizationINDV6729FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYInsuredPremium and RatingYesAdditional Monies Received; Premium Refunded; Rate Problem Resolved2012-08-27T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass2623Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN6731ACE AMERICAN INSURANCE COMPANYConsumer (Non-Insured)Closed-Lack Of Info CmplainantNoInsufficient Information2012-09-04T00:00:002012-12-05T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company2327Ins Co - Licensed/ActiveOrganizationINDV6732AMERICAN NATIONAL LLOYDS INSURANCE COMPANYConsumer (Non-Insured)Unsatisfactory Settle/OfferNoInformation Furnished; Question of Fact; Additional Payment Expected2012-08-28T00:00:002012-10-30T00:00:00Property and CasualtyHomeownersHomeownersInsured7613Ins Co - Licensed/ActiveOrganizationORGDAMAGE DISPUTE; GR-Claim Evaluation; HAIL; OVERHEAD AND PROFIT; ROOF6733TEXAS MEDICAID & HEALTHCARE PARTNERSHIPOtherTimely Filing DeficiencyNoNo Jurisdiction2012-09-25T00:00:002012-10-22T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured66518Govermental EntityOrganizationORG6735TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredCancellationNoInformation Furnished; Cancellation Withdrawn2012-08-27T00:00:002012-10-26T00:00:00Property and CasualtyHomeownersHomeowners1444TWIAOrganizationINDV6736PRUDENTIAL INSURANCE COMPANY OF AMERICA, THEInsuredUnsatisfactory Settle/OfferYesContract Language/Legal Issue2012-08-23T00:00:002012-12-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1729Ins Co - Licensed/ActiveOrganizationINDV6737GOLDEN RULE INSURANCE COMPANYInsuredContinuity Of TreatmentYesClaim Settled2012-08-22T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H1057Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6738AMERICAN UNITED LIFE INSURANCE COMPANYInsuredDelays (Policyholder Service)YesContract Language/Legal Issue; Additional Monies Received2012-08-23T00:00:002012-11-27T00:00:00Life, Accident and HealthLife & AnnuityGroup Annuities3668Ins Co - Licensed/ActiveOrganizationINDVSENIOR CITIZEN6739NATIONAL LLOYDS INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Question of Fact; Company Position Upheld2012-08-27T00:00:002012-11-05T00:00:00Property and CasualtyHomeownersHomeowners1914Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; HAIL; ROOF6740HUMANA INSURANCE COMPANYProviderUnsatisfactory Settle/Offer; Usual And CustomaryYesAdditional Monies Received2012-08-24T00:00:002012-10-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1040Ins Co - Licensed/ActiveOrganizationORG6741COLONIAL COUNTY MUTUAL INSURANCE COMPANYThird PartyDenial Of Claim; Liability DisputeNoInformation Furnished; Additional Monies Received; Claim Settled2012-08-28T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass2455Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; GR-Claim Evaluation6742COMMUNITY FIRST HEALTH PLANS, INC.InsuredDelays (Claims Handling)NoNo Jurisdiction2012-08-23T00:00:002012-11-27T00:00:00Medicare HMOAccident and HealthIndividual A & H12210Health Maintenance OrgOrganizationINDVSENIOR CITIZEN6743Lowes Service AdvantageInsuredDelays (Claims Handling)YesClaim Settled2012-09-04T00:00:002012-11-13T00:00:00Property and CasualtyMiscellaneousWarranty Contract74316OtherOrganizationINDV6744AMERIGROUP TEXAS, INC.ProviderDenial Of ClaimNoInformation Furnished; No Jurisdiction2012-08-23T00:00:002012-10-31T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured8032Health Maintenance OrgOrganizationORG6746CONNECTICUT GENERAL LIFE INSURANCE COMPANYContracted ProviderDenial Of Claim; Prompt PayYesAdditional Monies Received2012-09-25T00:00:002012-11-07T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company2851Ins Co - Licensed/ActiveOrganizationORGCHIROPRACTIC6747GERBER LIFE INSURANCE COMPANYInsuredUsual And CustomaryNoInformation Furnished2012-08-30T00:00:002012-11-05T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HThird Party Admin-Licensed2465Ins Co - Licensed/ActiveOrganizationINDV6747HEALTH REINSURANCE MANAGEMENT PARTNERSHIP/CONVERSION OFFICEInsuredUsual And CustomaryNo2012-08-30T00:00:002012-11-05T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HThird Party Admin-Licensed56136Third Party AdministratorsOrganizationINDV6748SOUTHERN FARM BUREAU LIFE INSURANCE COMPANYInsurance CompanyUnauthorized ActsNoReferred To2012-08-29T00:00:002012-10-30T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life1523Ins Co - Licensed/ActiveOrganizationORG6748RICHARDSON, SHANNA ELIZABETHInsurance CompanyAgent/Agency Contrct TerminNo2012-08-29T00:00:002012-10-30T00:00:00Life, Accident and HealthLife & AnnuityIndividual Life351818AgentIndividualORG6749GOVERNMENT EMPLOYEES HEALTH ASSOCIATION, INC.ProviderOvercharges; Usual And CustomaryNoNo Jurisdiction2012-08-28T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured49857Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation6751ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYInsuredDenial Of Claim; Unsatisfactory Settle/OfferNoAdditional Monies Received; Contract Language/Legal Issue2012-08-30T00:00:002012-11-07T00:00:00Property and CasualtyHomeownersHomeowners936Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; DAMAGE DISPUTE; POLICY EXCLUSION6752AETNA LIFE INSURANCE COMPANYContracted ProviderDelays (Claims Handling)NoAdditional Monies Received2012-08-23T00:00:002012-10-24T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORG6754GEICO INDEMNITY COMPANYInsuredAgent Handling; Delays (Claims Handling); Denial Of ClaimNoContract Language/Legal Issue2012-09-04T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass2785Ins Co - Licensed/ActiveOrganizationINDV6755ASC Benefit Services IncProviderDelays (Claims Handling)NoInsufficient Information2012-08-27T00:00:002012-11-06T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Person; Insured74320Insurance AgencyOrganizationORG6756ONEBEACON INSURANCE COMPANYInsuredDenial Of Claim; MisrepresentationNoContract Language/Legal Issue2012-08-17T00:00:002012-11-08T00:00:00Property and CasualtyMiscellaneousP & C MiscAssociated Subject Agency1745Ins Co - Licensed/ActiveOrganizationINDV6757ALLSTATE INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoAdditional Monies Received2012-09-04T00:00:002012-11-19T00:00:00Property and CasualtyHomeownersHomeowners168Ins Co - Licensed/ActiveOrganizationORG6758STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANYThird PartyDenial Of ClaimNoQuestion of Fact; Information Furnished; Contract Language/Legal Issue2012-08-31T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent1510Ins Co - Licensed/ActiveOrganizationINDV6759BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredAccess to Care; Delays (Policyholder Service)NoClaim Settled; Information Furnished2012-08-30T00:00:002012-11-09T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H10047Ins Co - Licensed/ActiveOrganizationINDV6760TEXAS STAR NETWORK/COVENTRYInsuredContinuity Of TreatmentNoInformation Furnished2012-09-04T00:00:002012-12-11T00:00:00Workers Compensation NetworkAccident and HealthIndividual A & HAssociated Subject Company; Correspondent Person55311WC Healthcare Provider NtwkOrganizationINDV6761NATIONWIDE LLOYDSInsuredUnsatisfactory Settle/OfferNoInformation Furnished; Company Position Upheld2012-09-04T00:00:002012-11-25T00:00:00Property and CasualtyHomeownersHomeowners870Ins Co - Licensed/ActiveOrganizationINDVDEDUCTIBLE; WATER DAMAGE6762HUMANA HEALTH PLAN OF TEXAS, INC.ProviderDelays (Claims Handling); Unsatisfactory Settle/OfferNoNo Jurisdiction; Information Furnished2012-08-27T00:00:002012-10-31T00:00:00Health Maintenance OrgAccident and HealthGroup A&HInsured702Health Maintenance OrgOrganizationORGBUNDLING6763PROPERTY AND CASUALTY INSURANCE COMPANY OF HARTFORDInsuredUse Of Clue ReportsYesCorrective Action Taken; Information Furnished; Company Position Upheld2012-08-29T00:00:002012-12-07T00:00:00Property and CasualtyHomeownersHomeownersInsured8123Ins Co - Licensed/ActiveOrganizationINDVROOF; SENIOR CITIZEN; UNDERWRITING CRITERIA; WATER DAMAGE6766Amerigroup CorporationContracted ProviderDenial Of ClaimNoNo Jurisdiction2012-08-31T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H45002Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN6767OLD AMERICAN COUNTY MUTUAL FIRE INSURANCE COMPANYThird PartyDelays (Claims Handling)NoClaim Settled; Additional Monies Received2012-08-28T00:00:002012-10-11T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency1823Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING6768LIBERTY MUTUAL INSURANCE COMPANYThird PartyDenial Of ClaimYesClaim Settled; Information Furnished; Additional Monies Received2012-08-31T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured Company2210Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING6769BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-13T00:00:002012-10-11T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV6771PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYThird PartyDelays (Claims Handling); Liability DisputeYesOther2012-09-04T00:00:002012-11-21T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDV6773BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredUnsatisfactory Settle/OfferNoAdditional Monies Received2012-08-24T00:00:002012-11-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationINDV6774FIRST HEALTH TX HCNInjured EmployeeAccess to Care; Denial Of ClaimNoInformation Furnished2012-08-31T00:00:002012-11-14T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkAssociated Subject Company54667WC Healthcare Provider NtwkOrganizationINDV6775TEXAS HEALTHSPRING, LLCInsuredNot Within TDI JurisdictionNoInformation Furnished; No Jurisdiction2012-08-24T00:00:002012-11-05T00:00:00Medicare HMOAccident and HealthGroup A&H18634Health Maintenance OrgOrganizationINDVMEDICARE PART D6776STATE FARM LLOYDSInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-09-04T00:00:002012-11-07T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation; ROOF6777STATE FARM LLOYDSInsuredCancellationNoInsufficient Information; No Jurisdiction2012-08-31T00:00:002012-11-16T00:00:00Property and CasualtyHomeownersHomeowners3105Ins Co - Licensed/ActiveOrganizationINDVWATER DAMAGE6780AETNA LIFE INSURANCE COMPANYInsuredDelays (Claims Handling)YesAdditional Monies Received2012-08-30T00:00:002012-11-08T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company245Ins Co - Licensed/ActiveOrganizationINDVPRESCRIPTION6782AMERICAN RISK INSURANCE COMPANY, INC.InsuredRefund Of PremiumNoInformation Furnished2012-08-31T00:00:002012-10-27T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency27377Ins Co - Licensed/ActiveOrganizationINDVCOVERAGE DISPUTE; UNDERWRITING CRITERIA6782BELL, WALTER BERNARDInsuredAgent HandlingNoAdditional Monies Received2012-08-31T00:00:002012-10-27T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency404602AgentIndividualINDVCOVERAGE DISPUTE; UNDERWRITING CRITERIA6783BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderDelays (Claims Handling)YesClaim Settled2012-08-24T00:00:002012-11-14T00:00:00Health Maintenance OrgAccident and HealthGroup A&H10047Health Maintenance OrgOrganizationORGGR-Claim Evaluation6784GERMANIA FARM MUTUAL INSURANCE ASSOCIATIONInsuredUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-08-29T00:00:002012-11-05T00:00:00Property and CasualtyHomeownersHomeownersCorrespondent Person2468Ins Co - Licensed/ActiveOrganizationINDVACV; DEDUCTIBLE6784NORRIS, RHONDAInsuredAgent Handling; MisrepresentationNoInformation Furnished2012-08-29T00:00:002012-11-05T00:00:00Property and CasualtyHomeownersHomeownersCorrespondent Person78630AgentIndividualINDVACV; DEDUCTIBLE6789ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Question of Fact2012-08-31T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6790UMR, INC.ProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-27T00:00:002012-11-30T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured23490Self-Funded / ErisaOrganizationORG6791ACCC INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoInformation Furnished; Additional Monies Received; Company Position Upheld2012-08-27T00:00:002012-10-30T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured9825Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING6792UNITED SERVICE AUTOMOBILE ASSOCIATIONInsuredUnsatisfactory Settle/OfferNoInformation Furnished; No Jurisdiction2012-08-20T00:00:002012-10-29T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Company72753Ins Co - Licensed/ActiveOrganizationINDVBURDEN OF PROOF; DAMAGE DISPUTE; HAIL; ROOF6793GRAMERCY INSURANCE COMPANYThird PartyDelays (Claims Handling)NoCompany Position Upheld; Contract Language/Legal Issue; Information Furnished2012-08-29T00:00:002012-10-27T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Company1062Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING6795PRAETORIAN INSURANCE COMPANYInsuredOtherYesAdditional Monies Received; Corrective Action Taken2012-09-04T00:00:002012-10-29T00:00:00Property and CasualtyHomeownersHomeowners687Ins Co - Licensed/ActiveOrganizationINDV6796AMERICAN HEALTH AND LIFE INSURANCE COMPANYInsuredDenial Of ClaimYesAdditional Monies Received2012-08-27T00:00:002012-11-29T00:00:00Life, Accident and HealthAccident and HealthGroup A&H161Insurance AgencyOrganizationINDV6799AETNA LIFE INSURANCE COMPANYProviderUnsatisfactory Settle/Offer; Usual And CustomaryNoNo Jurisdiction2012-08-28T00:00:002012-10-22T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured245Ins Co - Licensed/ActiveOrganizationORGGR-Claim Evaluation6800FARMERS TEXAS COUNTY MUTUAL INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoClaim Settled2012-09-04T00:00:002012-11-08T00:00:00Property and CasualtyAutomobileIndividual Private PassInsured2623Ins Co - Licensed/ActiveOrganizationINDVAFTERMARKET PARTS; GR-Claim Evaluation6801OLD REPUBLIC INSURANCE COMPANYThird PartyDelays (Claims Handling)YesAdditional Payment Expected; Information Furnished; Failure to Timely Respond2012-08-29T00:00:002012-11-26T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Person; Insured Company1830Ins Co - Licensed/ActiveOrganizationINDVADJUSTER'S HANDLING; UNCOOPERATIVE INSURED6802PROGRESSIVE COUNTY MUTUAL INSURANCE COMPANYInsuredDenial Of ClaimNoInformation Furnished; Question of Fact2012-08-31T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private Pass1708Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6803DELTA DENTAL INSURANCE COMPANYProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue2012-08-24T00:00:002012-11-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person2752Ins Co - Licensed/ActiveOrganizationORG6804LIBERTY HEALTH CARE NETWORKNon-Contracted ProviderDenial Of ClaimNoInformation Furnished2012-08-21T00:00:002012-11-14T00:00:00Workers Compensation NetworkMiscellaneousWorkers' Compensation NtwkCorrespondent Person; Injured Employee54531WC Healthcare Provider NtwkOrganizationORG6805AMERICAN ACCESS CASUALTY COMPANYAttorneyDenial Of ClaimNoContract Language/Legal Issue2012-09-04T00:00:002012-11-25T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Subject Agency; Associated Subject Company; Insured30332Ins Co - Licensed/ActiveOrganizationINDVDRIVER NOT COVERED6808SAFE AUTO INSURANCE COMPANYInsuredDelays (Policyholder Service)NoInformation Furnished2012-08-30T00:00:002012-10-31T00:00:00Property and CasualtyAutomobileIndividual Private Pass25980Ins Co - Licensed/ActiveOrganizationINDV6809HUMANA INSURANCE COMPANYInsuredUnsatisfactory Settle/OfferYesContract Language/Legal Issue; Corrective Action Taken2012-08-27T00:00:002012-10-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&H1040Ins Co - Licensed/ActiveOrganizationINDV6810ALLSTATE FIRE AND CASUALTY INSURANCE COMPANYThird PartyUnsatisfactory Settle/OfferNoClaim Settled; Additional Monies Received2012-08-06T00:00:002012-11-16T00:00:00Property and CasualtyAutomobileIndividual Private Pass936Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6811CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANYProviderRecoupment Of Claims PaymentNoNo Jurisdiction2012-08-31T00:00:002012-11-06T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H25422Ins Co - Licensed/ActiveOrganizationORGSENIOR CITIZEN6812TEXAS WINDSTORM INSURANCE ASSOCIATIONInsuredRefund Of PremiumNoCompany Position Upheld2012-08-31T00:00:002012-12-17T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency1444Ins Co - Licensed/ActiveOrganizationINDV6812MURPHY, CHRISTOPHER VERNONInsuredConversionYesReferred for Disciplinary Actn; Failure to Timely Respond2012-08-31T00:00:002012-12-17T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Agency659500AgentIndividualINDV6813BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderRecoupment Of Claims PaymentNoNo Jurisdiction2012-08-22T00:00:002012-10-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Self-Funded / ErisaOrganizationINDV6814GROUP & PENSION ADMINISTRATORS, INC.ProviderDelays (Claims Handling)NoNo Jurisdiction2012-08-30T00:00:002012-11-05T00:00:00Life, Accident and HealthAccident and HealthGroup A&H32390Self-Funded / ErisaOrganizationORGGR-Claim Evaluation6815UNITEDHEALTHCARE INSURANCE COMPANYNon-Contracted ProviderUnsatisfactory Settle/OfferNoInformation Furnished; Contract Language/Legal Issue2012-08-27T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&HCorrespondent Person; Insured1348Insurance AgencyOrganizationORG6817TEXAS FARMERS INSURANCE COMPANYInsuredDenial Of ClaimNoCompany Position Upheld; Contract Language/Legal Issue2012-09-05T00:00:002012-11-29T00:00:00Property and CasualtyHomeownersHomeowners1452Ins Co - Licensed/ActiveOrganizationINDVDAMAGE DISPUTE; GR-Claim Evaluation; MOLD6818JOHN HANCOCK LIFE & HEALTH INSURANCE COMPANYInsuredCancellation; Delays (Policyholder Service); Non-Renewal; Premium Notice; Refund Of PremiumNoCancel/Non-Renewal Upheld2012-08-28T00:00:002012-11-03T00:00:00Life, Accident and HealthAccident and HealthIndividual A & H632Ins Co - Licensed/ActiveOrganizationINDVREPLACEMENT VEHICLE6820TEXAS FARM BUREAU MUTUAL INSURANCE COMPANYInsuredOtherNoCompany Position Upheld2012-08-10T00:00:002012-11-17T00:00:00Property and CasualtyMiscellaneousNo Line Specified1450Ins Co - Licensed/ActiveOrganizationINDV6821UNION FIDELITY LIFE INSURANCE COMPANYRelativeCash ValueNoInformation Furnished; Contract Language/Legal Issue2012-08-23T00:00:002012-11-02T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured2783Ins Co - Licensed/ActiveOrganizationINDV6822Driggs Title Agency, Inc.Consumer (Non-Insured)Agent HandlingNoInformation Furnished2012-08-31T00:00:002012-11-09T00:00:00Property and CasualtyMiscellaneousTitle Insurance74333AgentOrganizationINDV6823AETNA LIFE INSURANCE COMPANYNon-Contracted ProviderRecoupment Of Claims PaymentYesAdditional Monies Received2012-08-27T00:00:002012-10-27T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Ins Co - Licensed/ActiveOrganizationORG6825LOYA INSURANCE COMPANYConsumer (Non-Insured)Unauthorized ActsNoInformation Furnished2012-08-31T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private Pass15643Ins Co - Licensed/ActiveOrganizationINDVADVERTISING6826GOVERNMENT EMPLOYEES INSURANCE COMPANYInsuredNon-Renewal; Unsatisfactory Settle/OfferNoInformation Furnished2012-08-31T00:00:002012-11-08T00:00:00Property and CasualtyAutomobileIndividual Private Pass2486Ins Co - Licensed/ActiveOrganizationINDV6827BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONPhysicianUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-27T00:00:002012-10-19T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured10047Ins Co - Licensed/ActiveOrganizationINDV6828BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONProviderUnsatisfactory Settle/OfferNoNo Jurisdiction2012-08-23T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&H10047Ins Co - Licensed/ActiveOrganizationORG6829UNITEDHEALTHCARE INSURANCE COMPANYInsuredDelays (Claims Handling); Denial Of ClaimYesPolicy Not In Force2012-08-24T00:00:002012-11-01T00:00:00Life, Accident and HealthAccident and HealthGroup A&HInsured1348Ins Co - Licensed/ActiveOrganizationINDV6830STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXASInsuredDenial Of ClaimNoInformation Furnished; Question of Fact2012-08-31T00:00:002012-10-29T00:00:00Property and CasualtyAutomobileIndividual Private PassAssociated Agent1506Ins Co - Licensed/ActiveOrganizationINDVGR-Claim Evaluation6831AETNA LIFE INSURANCE COMPANYHospitalDelays (Claims Handling)NoNo Jurisdiction2012-08-23T00:00:002012-10-16T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Self-Funded / ErisaOrganizationORG6833AETNA LIFE INSURANCE COMPANYPhysicianDenial Of ClaimNoNo Jurisdiction2012-08-22T00:00:002012-10-31T00:00:00Life, Accident and HealthAccident and HealthGroup A&H245Self-Funded / ErisaOrganizationINDV6834SAFECO INSURANCE COMPANY OF INDIANAInsuredCust Service Claim Handling; Unsatisfactory Settle/OfferNoInformation Furnished; Additional Payment Expected; Contract Language/Legal Issue2012-08-31T00:00:002013-06-10T00:00:00Property and CasualtyHomeownersHomeownersAssociated Subject Person2496Ins Co - Licensed/ActiveOrganizationINDVHAIL; ROOF6835lovelace insuranceInsuredDelays (Claims Handling)NoInsufficient Information2012-08-28T00:00:002012-12-12T00:00:00Life, Accident and HealthAccident and HealthIndividual A & HAssociated Subject Company; Associated Subject Person77451AgentOrganizationINDVGR-Claim Evaluation6836STONEBRIDGE LIFE INSURANCE COMPANYRelativeDelays (Policyholder Service)NoInformation Furnished2012-08-27T00:00:002012-10-26T00:00:00Life, Accident and HealthLife & AnnuityIndividual LifeInsured2269Ins Co - Licensed/ActiveOrganizationINDV6837BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATIONInsuredDenial Of Claim; Timely Filing DeficiencyNoNo Jurisdiction2012-08-24T00:00:002012-10-21T00:00:00Life, Accident and HealthAccident and HealthGroup A&HAssociated Subject Company10047Ins Co - Licensed/ActiveOrganizationINDV6838national agents allianceAgentAgent/Agency Contrct Termin; Unauthorized ActsNoNo Jurisdiction2012-07-06T00:00:002012-10-30T00:00:00Property and CasualtyMiscellaneousMortgage Guaranty74336Insurance AgencyOrganizationINDV6839Oxford Health Plans, Inc.ProviderUnsatisfactory Settle/OfferNoContract Language/Legal Issue; No Jurisdiction2012-08-30T00:00:002012-12-17T00:00:00Health Maintenance OrgAccident and HealthGroup A&HAssociated Subject Company; Insured77562