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Maine.gov > PFR Home > Insurance Regulation > Bureau Reports > Foreign Company Examination Reports > Arch Ins Co
Market Conduct Examination
ARCH INSURANCE COMPANY
300 First Stamford Place
|WCB-1, First Report of Injury||39-A M.R.S.A. § 303
Rules & Regs, Ch 8 § 13
|WCB-2, Wage Statement||39-A M.R.S.A. § 303|
|WCB-2A, Schedule of Dependent(s) And Filing Status||39-A M.R.S.A. § 303|
|WCB-3, Memorandum of Payment||Rules & Regs, Ch 1 § 1.1|
|WCB-4, Discontinuance or Modification of
|Rules & Regs, Ch 8 § 11|
|WCB-4A, Consent Between Employer and Employee||Rules & Regs, Ch 8 § 18|
|WCB-8, (21 Day) Certificate of Discontinuance or
Reduction of Compensation
|39-A M.R.S.A. § 205 (9)|
|WCB-9, Notice of Controversy (NOC)||Rules & Regs, Ch 1 § 1.1|
|WCB-11, Statement of Compensation Paid||Rules & Regs, Ch 8 § 1|
Standard G-4 establishes a general framework for the timely correspondence of claim documentation. Failure to file any WCB forms within established time frames is a violation of 39-A M.R.S.A. § 360(1)(A) or (B).
(2) Standard G-3
Claims are resolved in a timely manner.
Test Step 2: Determine if initial and subsequent claim payments are made in a timely manner.
Standard G-3 establishes a general framework for the timely settlement of claims in accordance with 39-A M.R.S.A. § 205(2).
(3) Standard G-5
Claim files are adequately documented.
Test Step 3: Determine if quality of the claim documentation (e.g. wage statements, schedule of dependents and filing status) is sufficient to support or justify the ultimate claim determination (accuracy of payment) and meets state requirements.
Standard G-5 establishes a general framework for the adequacy of claim file documentation to correctly calculate claim payments in accordance with 39-A M.R.S.A. § 212, § 213 and § 215.
This section outlines the application of the tests to the claims selected. The results of testing those open indemnity claims during the examination period are delineated in the following tables:
TEST 1: Verify the timely filing of the following forms with the Workers' Compensation Board in accordance with the applicable Statute, Rules & Regulations, or Protocol:
(A) - For comparative purposes, these compliant percentages are taken from the WCB Compliance Audit Report conducted on January 1, 2004 thru December 31, 2004 data. It should be noted that the total number of lost time claims reviewed by the Board in their audit was nine.
TEST 2: Verify that initial and subsequent indemnity payments were made in accordance with 39-A M.R.S.A. § 205 (2).
|Paid Timely||Not Paid
|Initial Payment||0||0||5||NA||50 %|
|Subsequent Payments||2||0||3||100%||82 %|
The data in the table representing Test 2 refer to claim files rather than individual subsequent payments.
TEST 3: Verify that the average weekly wages are calculated accurately and the subsequent indemnity payments are calculated accurately for both total and partial incapacity.
|Partial & Total Indemnity Payments||1||0||4||100%||50%|
Numbers in this table represent number of claims rather than each specific calculation or payments.
In reviewing the information contained in this report, it is important to keep in mind the WCB's
benchmarks for routine monitoring of claims. The benchmark for timely initial indemnity
payments is 80% compliance and for timely filing of memorandum of payments (WCB-3) the
benchmark is 75% compliance.
This report does not contain a section on Comments and Recommendations for the Company primarily because of the small population of claims available for review. We note that the Company used a third-party administrator, Cambridge Integrated Services, Inc. (CISI), which the Bureau also examined at the same time. The Company is responsible for its TPA's performance. We recommend that the Company take steps to monitor the TPA's compliance with the WCA.
The courtesy and cooperation extended by the officers and employees of the Company during the course of the Examination is hereby acknowledged. The Examination was conducted and is respectfully submitted by the undersigned.
STATE OF MAINE
COUNTY OF KENNEBEC, SS
Van E. Sullivan, being duly sworn according to law, deposes and says that in accordance with the authority vested in he by Eric A. Cioppa, Acting Superintendent of Insurance, pursuant to the Insurance Laws of the State of Maine, he has made an examination on the condition and affairs of the
Arch Insurance Company
As described in the scope of examination section of the report, subscribed to by him, is true to the best of his knowledge and belief.
Van E. Sullivan
Market Conduct Division Supervisor
Subscribed and sworn to before me
This 25 day of February, 2008
Patricia A. Galouch, Notary Public
My commission expires: March 2, 2014
Last Updated: September 12, 2013
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