Monday, October 26, 2009

Appeals court upholds certification of class-action suit against Farmers Insurance

OKLAHOMA CITY – The Oklahoma Court of Civil Appeals has upheld certification of a class-action lawsuit against Farmers Insurance Company Inc. and related companies over the way Farmers processed, reviewed and denied medical-pay claims for some policyholders.

According to the court’s opinion, in late 2000 Farmers started having such claims reviewed by Zurich Services Corp., a claims management company owned by Farmers that maintains a large database of charges billed by medical providers.“ZSC compares each incoming Farmers’ policyholder’s medical bill against the database, and ‘flags’ a charge as potentially unreasonable whenever it exceeds the 80th percentile of all charges in the database for the relevant PSRO (Professional Standards Review Organization) service,” the court said.
Farmers contended that Zurich individually reviews flagged charges, finding some unreasonable and notifying the provider or policyholder it is reducing or denying payment.
In their lawsuit, the plaintiffs allege that Farmers systemically uses the 80th percentile audit/review process to wrongfully deny payment or reimbursement of policyholders’ medical expenses in a predetermined way, regardless of whether a particular expense is unreasonable, mainly to reduce Farmers’ costs.
The plaintiffs sought class certification only on a breach of contract claim, although they have alleged causes of action for bad faith, unjust enrichment, fraud, deceit and conspiracy to commit a tortuous act.
The trial court’s order, which granted class certification, stated that Farmers writes the policy in 14 states, including Oklahoma. The trial judge found that, in Oklahoma alone, thousands of claims were adjusted annually using the 80th-percentile method.
That court also found that each claim was small and costly to litigate individually and that such litigation would be burdensome to the courts.
Writing for the court, Presiding Judge Doug Gabbard said the record supports that finding.
“Having considered all the facts and circumstances, we find that the core issues of the case present common factual and legal questions, and also find that a class action is superior to other forms of adjudication,” the appeals court concluded.
A Farmers attorney declined to discuss the court’s opinion.
Farmers could seek a rehearing before the civil appeals court or ask the Oklahoma Supreme Court to hear the case. The certification order could also be modified by the district court.
A plaintiff’s attorney did not return a phone call seeking comment.

Source: journalrecord.com

Labels: , , , , , , ,

Wednesday, September 02, 2009

Zurich Net Income Drops 53% As Recession Takes Toll

NU Online News Service, Sept. 2, 3:30 p.m. EDT

Zurich Financial Services Group reported a net income drop of 53 percent for the first half of the year as the recession continued to take a toll on the company’s earnings.

Despite the drop, James J. Schiro, Zurich’s chief executive officer, emphasized that the company still managed a profit even with the challenges it faced.

“We are effectively managing our way through this crisis,” Mr. Schiro said during an analyst’s discussion of the results today.

The Zurich-based insurer of property and casualty and life products reported net income dropped $1.43 billion to $1.24 billion for the first half of the year.

General insurance reported an operating profit of $1.7 billion, compared to $2.24 billion for the same period last year, a drop of 23 percent. The combined ratio for the segment remained flat at 96.2.

Mr. Schiro called the company’s results “outstanding” and said Zurich is in a position of strength to take advantage of the economic turnaround that lies ahead.

Such a turnaround, he noted, would not happen quickly, and the improvement in the investment markets has only brought the company’s investment portfolios back to “pre-crisis” levels.

He said many companies are struggling with the current recession, declaring it the “greatest economic dislocation in a generation.”

He said the insurer is taking a disciplined approach to risk, refusing to chase volume and pushing for increased rates, which have risen by 4 percent in the past quarter.

The company continues to push efficiency, he said, with $900 million in improvement under its Zurich Way plan and an additional $400 million in expense reductions.

He said Farmers’ Insurance, the insurance exchange the company does not own but manages, is well on its way to growth as it integrates its purchase of American International Group’s Personal Auto Group into its operations.

Zurich plans to make acquisitions, he said, so long as they make economic sense.

Zurich Chief Financial Officer Dieter Wemmer noted that despite the economic downturn, the company’s solvency was never threatened. During the conference, he displayed a graph illustrating the sharp downturn in profitability the company took between the second- and third quarter of 2008 and the steady increase in profitability it has seen since. Net income has increased from $154 million in the third quarter of 2008 to $892 million for the second quarter of this year.

“We stayed the course,” Mr. Schiro told analysts. “Let’s not lose site of the fact that we reported a profit when others reported losses.”

NU Online News Service, Sept. 2, 3:30 p.m. EDT

Zurich Financial Services Group reported a net income drop of 53 percent for the first half of the year as the recession continued to take a toll on the company’s earnings.

Despite the drop, James J. Schiro, Zurich’s chief executive officer, emphasized that the company still managed a profit even with the challenges it faced.

“We are effectively managing our way through this crisis,” Mr. Schiro said during an analyst’s discussion of the results today.

The Zurich-based insurer of property and casualty and life products reported net income dropped $1.43 billion to $1.24 billion for the first half of the year.

General insurance reported an operating profit of $1.7 billion, compared to $2.24 billion for the same period last year, a drop of 23 percent. The combined ratio for the segment remained flat at 96.2.

Mr. Schiro called the company’s results “outstanding” and said Zurich is in a position of strength to take advantage of the economic turnaround that lies ahead.

Such a turnaround, he noted, would not happen quickly, and the improvement in the investment markets has only brought the company’s investment portfolios back to “pre-crisis” levels.

He said many companies are struggling with the current recession, declaring it the “greatest economic dislocation in a generation.”

He said the insurer is taking a disciplined approach to risk, refusing to chase volume and pushing for increased rates, which have risen by 4 percent in the past quarter.

The company continues to push efficiency, he said, with $900 million in improvement under its Zurich Way plan and an additional $400 million in expense reductions.

He said Farmers’ Insurance, the insurance exchange the company does not own but manages, is well on its way to growth as it integrates its purchase of American International Group’s Personal Auto Group into its operations.

Zurich plans to make acquisitions, he said, so long as they make economic sense.

Zurich Chief Financial Officer Dieter Wemmer noted that despite the economic downturn, the company’s solvency was never threatened. During the conference, he displayed a graph illustrating the sharp downturn in profitability the company took between the second- and third quarter of 2008 and the steady increase in profitability it has seen since. Net income has increased from $154 million in the third quarter of 2008 to $892 million for the second quarter of this year.

“We stayed the course,” Mr. Schiro told analysts. “Let’s not lose site of the fact that we reported a profit when others reported losses.”

Source: property-casualty.com

Labels: , , , , ,