News Flash:

California Department of Insurance Takes Action Against Insurer for Unfair Claims Handling Practices. Alleged mishandled claims include long term care, disability income and life insurance.

The California Department of Insurance today announced the filing of an administrative enforcement action against RiverSource Life Insurance Company for unfair claims handling practices affecting claims under long term care, disability income and life insurance policies.

The enforcement action focuses primarily on long term care policies and alleges that RiverSource mishandled numerous long term care claims and failed to adopt practices to assure that long term care and other policy benefits were paid. The action also alleges that RiverSource adopted business practices that were specifically designed to deny long term care benefits. The long term care claims typically involved persons in their 70's, 80's and 90's, including persons suffering from Alzheimer's disease and other impairments.

In addition to numerous examples of deficient claims handling, the enforcement action alleges that RiverSource systematically delayed investigating claims and intentionally created impediments to receiving policy benefits. Among other practices, RiverSource would not reasonably assist long term care policyholders in locating care facilities, requiring them to guess which facilities RiverSource might pay for, and putting them at risk of either receiving no benefits or moving multiple times until they found a facility that RiverSource would approve.

The enforcement action also alleges that RiverSource systematically denied coverage in facilities by requiring strict compliance with antiquated policy language drafted decades ago that no longer reasonably applies to the long term care industry.

The action is based on a Department of Insurance market conduct examination of RiverSource's own claims handling files. The action seeks penalties based on the violations found in the examination, plus penalties based on a proportional extrapolation of the violations found in the examination to all California claims handled by RiverSource.

The Insurance Code provides for penalties of up to $10,000 for each willful claims handling violation, $10,000 for each willful violation of long term care laws in particular, and $500,000 for each long term care general business practice in violation of long term care statutes.

Holiday Season Is Coming!!

The Holiday Season is quickly approaching, if you are planning a Holiday party for your office or personal and renting space for your event. Please contact TJM Insurance Services. We can offer $1,000,000 in coverage (limit) no open bar for $500.00 to $700.00 in premium. If you have an open bar and need Liquor Liability included we can offer $1,000,000 in coverage (limit) for $1,000.00 to $1,500.00

What does Employment Practices Liability protect me from:

Employment Practices Liability Insurance (EPLI) is designed to protect the business from suits and claims from alleged sexual misconduct, discrimination and wrongful termination.

What is Errors and Omissions Insurance?

Errors and Omissions Insurance helps protect our professional service firm clients from claims relating to an error or omission (mistake) in providing professional services that can lead to a lawsuit. An error or omission can occur on almost any transaction. It doesn’t matter how long you have been in business or how good you are. All Professional Service Firms are at risk. Our E&O insurance programs help provide protection for the busy professional from the liability associated with such errors, mistakes or omissions.

Workers Compensation In the State of California Q & A

Q. Do I need to have workers' compensation insurance?

A. Yes, California law requires employers to have workers' compensation insurance if they have even one employee. If you are a roofer and don’t have any employees, you are still required to carry workers’ compensation insurance.

Out-of-state employers may need workers' compensation coverage if an employee is regularly employed in California or a contract of employment is entered into here.

Q. My spouse and I are the sole owners of our business. We have no employees. Are we required to obtain workers' compensation coverage?

A. Generally, coverage for sole owners is optional. You would, however, need to have workers' compensation coverage for any employee you may hire, even if it’s just one employee, and even if it’s just temporary employment. You should consult with your attorney, insurance agent or broker, or carrier regarding the specifics of your situation and your options.