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The Collaborative Clearinghouse for Lawsuits and Other Claims Against ACE Group Insurance Companies

Texas Fines ACE American over Claims Failures

April 30, 2012 - ACE American Insurance Co. has paid an $8,500 fine to the Texas Department of Insurance after having admitted that it violated numerous provisions of the state’s workers’ compensation laws.

The Philadelphia-based unit of ACE Group was cited by the Texas Commissioner of Workers Compensation for failing to comply with commission orders, among other findings. That applied to three instances one of which involved a contested case hearing decision in which ACE failed to comply in a timely manner. In another instance, the state advised ACE that a decision by a hearing officer regarding benefits is final in the absence of a timely appeal by a party, and is binding during the pendency of an appeal to the appeals panel.

The consent order for disciplinary action also took ACE to task for failure to initiate payment of temporary income benefits - TIBs - in a timely manner. Those benefits are to be paid weekly as they accrue, but the state said that in one instance ACE neglected to do so.

In four separate instances, ACE was found to have violated a Texas code that requires insurers to timely process and take final action on a correctly completed request for reconsideration within 21 days of receipt of the request.

Other complaints against the company include:

-    Returning a completed medical bill, which it should not have done.

-    ACE failed to take timely action on a properly completed medical bill. Texas Labor Code requires insurers to take action on medical bills no later than 45 days after they receive a complete form.

The Commission found that ACE violated state law in at least 12 instances. It did not order any administrative action against the company other than the fine, but indicated that failure to comply with the order subjects the company to stiffer penalties.

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