U.S. DOL Resolves Lawsuit Involving Administrator for Maryland Health Plans

March 31, 2004

  • April 1, 2004 at 5:44 am
    Luke S. Brown says:
    Like or Dislike:
    Thumb up 0
    Thumb down 0

    Congrats to the DOL for successfully obtaining a consent order against SAI Plus.

    Without commenting upon SAI’s early operation, what is interesting is a subsequent connection between it and a company called, TRG, which proved to be a notorious unauthorized insurer. Having been intimately involved with the analysis of the plan, with Florida’s efforts to shut down TRG, to address consumer claims, future insurability problems, and coordinate efforts with insurance regulators nationwide, it was scary, but fascinating stuff.

    TRG, like most unauthorized health plans claimed ERISA exemption to state licensure requirements, including solvency oversight. Interstate cooperation of many insurance departments led to the successful closure of the operation, but unpaid claims issues continue to haunt consumers and providers.

    Florida law, like that of many states, imposes upon insurance licensees individual responsibility for unpaid claims of unauthorized insurers under certain circumstances, and state regulators are pursuing that method of recovery. In turn, because the underlying plan claimed to be an ERISA plan, some agents are facing coverage denials from their E&O carriers based upon ERISA exclusions.

    Unauthorized plans abound, and each generation of them becomes more complex. Detailed analysis and thorough due diligence is needed of every aspect; nothing can be taken for granted.

    Be careful.

    Luke Brown
    Tallahassee, Florida

Add a Comment

Your email address will not be published. Required fields are marked *