Fines from State Insurance Commissioner include Dental Health Services and American Pet Insurance

Wednesday, January 2, 2019

Mike Kreidler
State Insurance Commissioner
The Office of the State Insurance Commissioner monitors insurance related activities and responds to complaints about insurance providers which operate in the state. When there is fault, the office levies fines.

Two recent actions involved dental and pet insurance.

Dental Health Services, Seattle; fined $500,000, order 18-0437

Kreidler fined the dental insurer for:
  • Failing to identify and process 23 policyholders’ appeals.
  • Failing to identify and process 342 grievances from policyholders.
  • Erroneously canceling polices.
  • Double-charging 492 policyholders a total of $56,351. The company refunded the money with an additional $5,635 in interest. 
  • Failing to deliver enrollment materials to 76 policyholders. 
In addition to the fine, Kreidler will prohibit the company from selling new policies for at least 12 months. After the probationary period, the company can ask Kreidler to allow it to sell policies if it completes compliance and corrective action plans to the commissioner’s satisfaction. Kreidler is suspending $400,000 of the fine and will impose additional penalties if the company fails to comply with the terms of the order.

Kreidler previously took action against Dental Health Services in 2017 and 2018. Kreidler fined the company $400,000 for mishandling consumer complaints and other issues.

American Pet Insurance Co., New York City; fined $10,000, order 16-0127

Kreidler imposed $10,000 of a suspended fine against the pet insurance company for failing to follow the compliance plan it agreed to in July 2016. The plan includes a self-audit, which revealed that one policyholder was charged the incorrect premium and eight policyholders did not receive the required 30-day notice for a rate change. Kreidler previously suspended $100,000 of the $250,000 to ensure compliance with the terms of the order. This is the first portion of the suspended fine that Kreidler has imposed on the company.

If you have issues or questions about any kind of insurance, you can file a complaint at the webpage.

One caveat - the state only regulates medical insurance provided by insurance companies. Almost all the big companies are "self-funded" which means that they are acting as their own insurance company. As such, they are not regulated by the state. The companies contract with insurance companies to run their programs, so it's often impossible to tell if your insurer is self-funded (ask your Human Resources department).


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