790.03 v5 02-16-16

[IN ACCORDANCE WITH CALIFORNIA INSURANCE CODE (CIC) SECTION 12938, THIS REPORT WILL BE MADE PUBLIC AND PUBLISHED ON THE

CALIFORNIA DEPARTMENT OF INSURANCE (CDI) WEBSITE]

WEBSITE PUBLISHED REPORT OF THE MARKET CONDUCT EXAMINATION OF THE CLAIMS PRACTICES OF

GEICO MARINE INSURANCE COMPANY NAIC # 37923 CDI # 5171-4

AS OF JUNE 15, 2018

ADOPTED NOVEMBER 30, 2018

STATE OF CALIFORNIA

CALIFORNIA DEPARTMENT OF INSURANCE MARKET CONDUCT DIVISION

FIELD CLAIMS BUREAU

790.03 v5 02-16-16

NOTICE

The provisions of Section 735.5(a) (b) and (c) of the California

Insurance Code (CIC) describe the Commissioner’s authority

and exercise of discretion in the use and/or publication of

any final or preliminary examination report or other

associated documents. The following examination report is

a report that is made public pursuant to California Insurance

Code Section 12938(b)(1) which requires the publication of

every adopted report on an examination of unfair or

deceptive practices in the business of insurance as defined

in Section 790.03 that is adopted as filed, or as modified or

corrected, by the Commissioner pursuant to Section 734.1.

790.03 v5 02-16-16

TABLE OF CONTENTS

FOREWORD ................................................................................................................... 1

SCOPE OF THE EXAMINATION ................................................................................... 2

EXECUTIVE SUMMARY ................................................................................................ 4

DETAILS OF THE CURRENT EXAMINATION .............................................................. 5

TABLE OF TOTAL ALLEGED VIOLATIONS ................................................................ 7

SUMMARY OF EXAMINATION RESULTS .................................................................. 10

1

790.03 v5 02-16-16

FOREWORD

This report is written in a “report by exception” format. The report does not

present a comprehensive overview of the subject insurer’s practices. The report

contains a summary of pertinent information about the lines of business examined,

details of the non-compliant or problematic activities that were discovered during the

course of the examination and the insurer’s proposals for correcting the deficiencies.

When a violation that reflects an underpayment to the claimant is discovered and the

insurer corrects the underpayment, the additional amount paid is identified as a

recovery in this report.

While this report contains violations of law that were cited by the examiner,

additional violations of CIC § 790.03 or other laws not cited in this report may also apply

to any or all of the non-compliant or problematic activities that are described herein.

All unacceptable or non-compliant activities may not have been discovered.

Failure to identify, comment upon or criticize non-compliant practices in this state or

other jurisdictions does not constitute acceptance of such practices.

Alleged violations identified in this report, any criticisms of practices and the

Company’s responses, if any, have not undergone a formal administrative or judicial

process.

This report is made available for public inspection and is published on the

California Department of Insurance website (www.insurance.ca.gov) pursuant to

California Insurance Code section 12938(b)(1).

2

790.03 v5 02-16-16

SCOPE OF THE EXAMINATION

Under the authority granted in Part 2, Chapter 1, Article 4, Sections 730, 733,

and 736, and Article 6.5, Section 790.04 of the California Insurance Code; and Title 10,

Chapter 5, Subchapter 7.5, Section 2695.3(a) of the California Code of Regulations, an

examination was made of the claim handling practices and procedures in California of:

GEICO Marine Insurance Company NAIC # 37923

Group NAIC # 0031

Hereinafter, the Company listed above also will be referred to individually as

GMIC, or the Company.

This examination covered the claim handling practices of the aforementioned

Company on Inland Marine and Ocean Marine claims closed during the period from

June 16, 2017 through June 15, 2018. The examination was made to discover, in

general, if these and other operating procedures of the Company conform to the

contractual obligations in the policy forms, the California Insurance Code (CIC), the

California Code of Regulations (CCR) and case law.

To accomplish the foregoing, the examination included:

1. A review of the guidelines, procedures, training plans and forms adopted by

the Company for use in California including any documentation maintained by the

Company in support of positions or interpretations of the California Insurance Code, Fair

Claims Settlement Practices Regulations, and other related statutes, regulations and

case law used by the Company to ensure fair claims settlement practices.

3

790.03 v5 02-16-16

2. A review of the application of such guidelines, procedures, and forms, by

means of an examination of a sample of individual claim files and related records.

3. A review of the California Department of Insurance’s (CDI) market analysis

results; and if any, a review of consumer complaints and inquiries about the Company

closed by the CDI during the period June 16, 2017 through June 15, 2018, a review of

previous CDI market conduct claims examination reports on the Company; and a review

of prior CDI enforcement actions.

The review of the sample of individual claim files was conducted at the offices of

the Company in Costa Mesa, California.

4

790.03 v5 02-16-16

EXECUTIVE SUMMARY

The Inland Marine and Ocean Marine claims reviewed were closed from June 16,

2017 through June 15, 2018, referred to as the “review period”. The examiners

randomly selected 129 GMIC claim files for examination. The examiners cited 37

alleged claims handling violations of the California Insurance Code and the California

Code of Regulations from this sample file review.

Findings of this examination included the failure to include the California fraud

warning on insurance forms; failure to include a statement in its claim denial that the

matter may be reviewed by the California Department of Insurance and upon

acceptance of the claim, to tender payment within 30 calendar days.

5

790.03 v5 02-16-16

DETAILS OF THE CURRENT EXAMINATION

Further details with respect to the examination and alleged violations are

provided in the following tables and summaries:

GMIC SAMPLE FILES REVIEW

LINE OF BUSINESS / CATEGORY CLAIMS IN

REVIEW PERIOD

SAMPLE FILES

REVIEWED

NUMBER OF ALLEGED

VIOLATIONS

Inland Marine / Personal Liability Paid 39 2 0

Inland Marine / Personal Liability CWP 33 2 1

Inland Marine / Personal Liability Denied 3 1 0

Inland Marine / Personal Property Paid 566 35 14

Inland Marine / Personal Property CWP 129 7 1

Inland Marine / Personal Property Denied 38 3 0

Inland Marine / Personal Emergency Services Paid

156 10 1

Inland Marine / Personal Emergency Services CWP

48 2 0

Ocean Marine / Personal Liability Paid 82 4 1

Ocean Marine / Personal Liability CWP 38 2 2

Ocean Marine / Personal Liability Denied 9 1 0

Ocean Marine / Personal Property Paid 588 32 13

Ocean Marine / Personal Property CWP 137 7 1

Ocean Marine / Personal Property Denied 49 3 1

Ocean Marine / Personal Emergency Services Paid

186 10 2

6

790.03 v5 02-16-16

Ocean Marine / Personal Emergency Services CWP

40 2 0

Ocean Marine / Commercial Liability Paid 6 1 0

Ocean Marine / Commercial Liability CWP 1 1 0

Ocean Marine / Commercial Property Paid 17 1 0

Ocean Marine / Commercial Property CWP 5 1 0

Ocean Marine / Commercial Property Denied 3 1 0

Ocean Marine / Commercial Emergency Services Paid

5 1 0

TOTALS 2178 129 37

7

790.03 v5 02-16-16

TABLE OF TOTAL ALLEGED VIOLATIONS

Citation Description of Allegation

GMIC Number of

Alleged Violations

CIC §1879.2(a) *[CIC §790.03(h)(3)]

The Company failed to include the California fraud warning on insurance forms related to first-party claimants.

26

CCR §2695.7(b)(3) *[CIC §790.03(h)(3)]

The Company failed to include a statement in its claim denial that, if the claimant believes all or part of the claim has been wrongfully denied or rejected, he or she may have the matter reviewed by the California Department of Insurance.

5

CCR §2695.7(h) *[CIC §790.03(h)(5)]

The Company failed, upon acceptance of the claim, to tender payment within 30 calendar days.

2

CCR §2695.7(g) *[CIC §790.03(h)(5)]

The Company attempted to settle a claim by making a settlement offer that was unreasonably low.

1

CCR §2695.7(c)(1) *[CIC §790.03(h)(3)]

The Company failed to provide written notice of the need for additional time or information every 30 calendar days.

1

CCR §2695.5(b) *[CIC §790.03(h)(2)]

The Company failed to respond to communications within 15 calendar days.

1

CCR §2695.7(b) *[CIC §790.03(h)(4)]

The Company failed, upon receiving proof of claim, to accept or deny the claim within 40 calendar days.

1

Total Number of Alleged Violations 37

*DESCRIPTIONS OF APPLICABLE UNFAIR CLAIMS SETTLEMENT PRACTICES

CIC §790.03(h)(2) The Company failed to acknowledge and act reasonably promptly upon communications with respect to claims arising under insurance policies.

8

790.03 v5 02-16-16

CIC §790.03(h)(3) The Company failed to adopt and implement reasonable standards for the prompt investigation and processing of claims arising under insurance policies.

CIC §790.03(h)(4) The Company failed to affirm or deny coverage of claims within a reasonable time after proof of loss requirements had been completed and submitted by the insured.

CIC §790.03(h)(5) The Company failed to effectuate prompt, fair, and equitable settlements of claims in which liability had become reasonably clear.

9

790.03 v5 02-16-16

TABLE OF ALLEGED VIOLATIONS BY LINE OF BUSINESS

MISCELLANEOUS (Inland Marine / Ocean

Marine) GMIC 2017 Written Premium: $14,337,281

AMOUNT OF RECOVERIES $1,750.00

NUMBER OF ALLEGED VIOLATIONS

CIC §1879.2(a) [CIC §790.03(h)(3)] 26

CCR §2695.7(b)(3) [CIC §790.03(h)(3)] 5

CCR §2695.7(h) [CIC §790.03(h)(5)] 2

CCR §2695.7(g) [CIC §790.03(h)(5)] 1

CCR §2695.7(c)(1) [CIC §790.03(h)(3)] 1

CCR §2695.5(b) [CIC §790.03(h)(2)] 1

CCR §2695.7(b) [CIC §790.03(h)(4)] 1

SUBTOTAL 37

TOTAL 37

10

790.03 v5 02-16-16

SUMMARY OF EXAMINATION RESULTS

The following is a brief summary of the criticisms that were developed during the

course of this examination related to the violations alleged in this report.

In response to each criticism, the Company is required to identify remedial or

corrective action that has been or will be taken to correct the deficiency. The Company

is obligated to ensure that compliance is achieved.

Any noncompliant practices identified in this report may extend to other

jurisdictions. The Company should address corrective action for other jurisdictions

when applicable.

Money recovered within the scope of this report was $1,750.00 as described in

section number 2 below. Pursuant to the findings of the examination, a closed claims

survey as described in section 2 and 6 below was conducted by the Company resulting

in additional payments of $15,224.45. As a result of the examination, the total amount

of money returned to claimants within the scope of this report was $16,974.45

INLAND MARINE 1. In 15 instances, the Company failed to include the California fraud warning on insurance forms related to first-party claimants. In each instance, the correct fraud warning was not included on the Sworn Statement in Proof of Loss. The Department alleges these acts are in violation of CIC §1879.2(a) and are unfair practices under CIC §790.03(h)(3). Summary of the Company’s Response: The Company agrees with the alleged violations and as a result of the examination, the Sworn Statement in Proof of Loss form template was immediately updated to include the correct language. A copy of the revised template letter was provided on August 29, 2018. In addition, training for all claims staff with emphasis on this insurance code was initiated on September 17, 2018 and completed on October 8, 2018. 2. In one instance, the Company attempted to settle a claim by making a settlement offer that was unreasonably low. In this instance, a tow bill

11

790.03 v5 02-16-16

reimbursement was underpaid due to an internal billing error. The Department alleges this act is in violation of CCR §2695.7(g) and is an unfair practice under CIC §790.03(h)(5). Summary of the Company’s Response: The Company acknowledges the alleged violation and states no consumers were harmed in this isolated instance. However, upon discovery of a system error that limited reimbursement payments between the Company and its sister company Boat America Corporation (BAC), the Company immediately issued the additional payment owed to the parent company, BAC, in the amount of $1,750.00. The Company conducted a self-audit looking at all tow claims, including California claims, filed from December 21, 2016 to June 18, 2018, identifying those California claims that were affected by the system error. As a result of the review, a total of $15,224.45 was reimbursed to BAC. In addition to the steps taken to address the system error, Company management has trained staff to monitor any future system updates promptly in order to prevent any similar issues in the future. 3. In one instance, the Company failed to include a statement in its claim denial that, if the claimant believes all or part of the claim has been wrongfully denied or rejected, he or she may have the matter reviewed by the California Department of Insurance. In this instance, a denial letter did not include the required language. The Department alleges this act is in violation of CCR §2695.7(b)(3) and is an unfair practice under CIC §790.03(h)(3).

Summary of the Company’s Response: The Company agrees with the alleged violation and that their procedure was not followed in this instance. As a result of the examination, the individuals involved were coached in the preparation and review of the denial letter and settlement decision to assure future compliance. In addition, training for all claims staff with emphasis on the regulation was initiated on September 17, 2018 and completed on October 8, 2018. OCEAN MARINE 4. In 11 instances, the Company failed to include the California fraud warning on insurance forms related to first-party claimants. In each instance, the correct fraud warning was not included on the Sworn Statement in Proof of Loss. The Department alleges these acts are in violation of CIC §1879.2(a) and are unfair practices under CIC §790.03(h)(3). Summary of the Company’s Response: The Company agrees with the alleged violations and as a result of the examination, the Sworn Statement in Proof of Loss form template was immediately updated to include the correct language. A copy of the revised template letter was provided on August 29, 2018. In addition, training

12

790.03 v5 02-16-16

for all claims staff with emphasis on the regulation was initiated on September 17, 2018 and completed on October 8, 2018. 5. In four instances, the Company failed to include a statement in its claim denial that, if the claimant believes all or part of the claim has been wrongfully denied or rejected, he or she may have the matter reviewed by the California Department of Insurance. In each instance, a denial letter did not include the required language. The Department alleges these acts are in violation of CCR §2695.7(b)(3) and are unfair practices under CIC §790.03(h)(3).

Summary of the Company’s Response: The Company agrees with the alleged violations and that their procedure was not followed in these instances. As a result of the examination, the individuals involved were coached in the preparation and review of the denial letter and settlement decision to assure future compliance. In addition, training for all claims staff with emphasis on the regulation was initiated on September 17, 2018 and completed on October 8, 2018.

6. In two instances, the Company failed, upon acceptance of the claim, to tender payment within 30 calendar days. In each instance, payment of the balance of the claim settlement following an initial payment of $250.00 was not issued timely due to an internal billing error. The Department alleges these acts are in violation of CCR §2695.7(h) and are unfair practices under CIC §790.03(h)(5). Summary of the Company’s Response: The Company acknowledges the alleged violations and agrees that a system error limited reimbursement payments between the Company and Boat America Corporation (BAC). Upon discovery of the error, the Company immediately issued the additional payments owed. Additional steps were made to correct the problem including conducting a self-audit, the results of which are explained in criticism number two. In addition to the steps taken to address the system error, Company management has trained staff to monitor any future system updates promptly in order to prevent any similar issues in the future. 7. In one instance, the Company failed to provide written notice of the need for additional time or information every 30 calendar days. A status letter was not sent timely in this instance. The Department alleges this act is in violation of CCR §2695.7(c)(1) and is an unfair practice under CIC §790.03(h)(3). Summary of the Company’s Response: The Company agrees with the alleged violation and states that this was an isolated instance in which a status letter providing notice of the need for additional time or information was not sent within the statutory time frame. As a result of the examination, the adjusters have been coached. In addition, training for all claims staff with emphasis on the regulation was initiated on September 17, 2018 and completed on October 8, 2018.

13

790.03 v5 02-16-16

8. In one instance, the Company failed to respond to communications within 15 calendar days. In this instance, there was no response to an e-mail from the insured. The Department alleges this act is in violation of CCR §2695.5(b) and is an unfair practice under CIC §790.03(h)(2). Summary of the Company’s Response: The Company agrees with the alleged violation and states this was an isolated instance. As a result of the examination, the insured was contacted. In addition, the adjuster was coached to ensure future compliance. In addition, training for all claims staff with emphasis on the regulation was initiated on September 17, 2018 and completed on October 8, 2018. 9. In one instance, the Company failed, upon receiving proof of claim, to accept or deny the claim within 40 calendar days. In this instance, a tow bill was not accepted or denied within the statutory period. The Department alleges this act is in violation of CCR §2695.7(b) and is an unfair practice under CIC §790.03(h)(4). Summary of the Company’s Response: The Company agrees with the alleged violation and states this was an isolated instance. As a result of the examination the adjuster was coached to ensure future compliance. In addition, training for all claims staff with emphasis on the regulation was initiated on September 17, 2018 and completed on October 8, 2018.