tv Hearing on Insurance Fraud CSPAN August 3, 2017 2:59pm-4:27pm EDT
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happen. i was hoping to get transportation in 2001. that's my background. i was a transportation banker for a number of years for bank of america. i had work for transportation companies so my whole background was actually in transportation. so it's nice now to be able to return to a field in which i had, you know, worked previously.
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>> welcome, everyone. as our title suggests, this subcommittee exercise is jurisdiction over a diverse range of topics. this will be our first hearing in this congress to examine matters related to insurance. specifically today that of insurance fraud. thank you for our expert witnesses who have joined us. insurance fraud is a major concern for insurers and also consumers who see those costs passed on to them in the form of
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higher premium's. we'll examine the scope of insurance fraud at large in the united states and address trends across a variety of insurance markets including and casualty and life insurance. in addition we'll discuss the tools available to states, insurers and consumers. there are nearly 3,000 property and body casualty insurance companies across the country. another 850 life and health insurance companies. together they generate over a trillion dollars in premiums in 2015 alone. criminals have confirm opportunities and bigger -- illegal activities. eliminating -- i'm sorry estimating the total cost of nonhealth insurance fraud of the united states at more than $40 billion annually. that in turn costs the average american family upwards of $700
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per year in the form of increased premiums. my staff is in communication with wells fargo regarding these concerns and we plan to follow up on the circumstances of what should be done. while insurance is largely regulated at the state level, insurance fraud schemes can and do lead to federal criminal charges. technology must and will play a crucial role in catching sophisticated fraud activity and i look forward to hearing more about the use of emerging
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technologies, data collection, and practices to better protect insurance fraud. thank you and thank you so much for having this hearing. before i giver some very, very brief opening remarks, i want to yield to the ranking member, my friend senator nelson for -- because he has to leave to go to a classified intelligence briefing this morning. >> and thank you for your courtesies mr. chairman
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that paralyzed marketplace of the state because of the monster hurricane andrew, insurance companies had fled the state of florida. there happened to be a lot of fraud committed in the course of all of that debacle. that is there today with huge reserves, the florida hurricane catastrophe fund. so as we look at the question of
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fraud, it hurts insurance companies and hurts the people and providers and the agents. it hurts people as well as consumers because of insurance fraud that is costly to those companies and of course it hurts individual consumers who are misled or deceived when they believe they are owed money for legitimate claims and they find that somehow there is fine print in the policy sometimes inserted or interpreted in ways they
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never thought possible. and that's why we're here today. i hope that you will not take personally the anger and frustration that i and others may express today. what we've seen, for example in connecticut, homeowners affected by a substance called -- insurance companies have modified their homeowner policies without telling them to exclude damage to a home's foundation once the insurance companies learn that those foundations have a potential and naturally occurring fault as a
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i saw all kinds of schemes and testimony is about misleading and sneaky insurance companies from americans across my state and connecticut ought to be of tremendous concern because attend of the day, would insurance have -- what insurance companies have that's most important to them is their credibility and reputation for honesty and instances like this even if they're -- literally millions tens of millions of dollars to ordinary consumers and they give vast majority of insurance companies and brokers and agents a bad name.
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i thank the chairman for having us all together today and i will be -- i've read your testimony and will be leaving for your testimony because i have a judiciary committee meeting but i'll be back for the questions. i apologize for my absence. -- the oklahoma insurance commissioner is here testifying on behalf of the national association of insurance commissioners. dennis jay coalition against insurance fraud. mr. sean kevlin, insurance information institute. tim lynch.
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we'll begin with you, commissioner. good morning chairman. members of the subcommittee. ranking member. i appreciate the opportunity to testify to provide state insurance regulator perspective. detection can be challenging. consumers do not frequently interact with insurance policies. premiums are typically paid annually and claims filed only upon injury, death or damage to property. with over 2 trillion on
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insurance spent per year with infrequent interactions, tempting windows of opportunity are created for criminals. 10% or more of the property casualty insurance claims may be fraudulent. state insurance regulators track several current trends in insurance fraud. for example, state insurance departments have seen contractor and adjuster fraud occurring after natural disasters. contractors or insurance adjusters require advance payment from consumers for services or advance assignment of insurance policy benefits and then disappear without ever doing the work. in cases where repairs are made, the contractor does shoddy work using sub standard materials. in oklahoma, my department's antifraud unit deploys to assess damage and educate consumers about fraud prevention. here's a photo of myself and the governor and state legislators
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they have established investigation units within the company and investing heavily in training and in technology. on that last point the sharing of claims data has been absolutely essential in helping to detect fraud. especially some of the schemes by these organized criminal enterprises that are defrauding billions of dollars. i would also like to mention that the property casualty industry also participates in the successful healthcare fraud prevention partnership. this is a collaborative effort in which tricare medicare, medicaid, the va share information on crooked medical
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and set penalties. 38 states have established antifraud units that investigate and prosecute insurance fraud. many of them have police powers. some of them have prosecutors within their departments that specifically only do insurance fraud and that has really done a lot to help over the last few years. there's a high level of collaboration between these state agencies and insurance companies in fighting fraud and that in part is spurred because most states do require insurance companies to report fraud and to sponsor active antifraud programs within the companies.
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also -- it's important that we have strategies that help to counter some of these trends. we need to understand we're still a long ways aways from turning the corner on insurance fraud. we feel through continued collaboration and perhaps some of these deterrent efforts we'll continue down the path of curbing insurance fraud and the associated costs to help save all americans some money. thank you. >> mr. jay, thank you very much.
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our mission is to explain what insurance does and how it works. our members are primarily property and casualty insurers although 70% of our members also offer life insurance solutions. more than $327 billion was paid out in 2015 to settle claims. many of those were to auto repair companies. this will undoubtedly be the case in 2017. insurance companies recognize the overwhelming -- in those
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cases, the claims are paid out promptly. in fact, the consumers are recognizing them. home insurers this year received their highest rankings ever. the relationship between insurers and consumers is one of trust. consumers trust that insurance will help rebuild. insurers -- result in all consumers having to pay higher premiums putting a strain on the trust in the relationship. and for this reason, the insurance industry is dedicated
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to doing whatever it can to prevent fraud. since the five years released its fraud study, insurers and the state regulatory departments have dramatically improved their efforts and we're hearing that today. insurers have allocated additional resources in their social investigation units or extra training. the california case -- never happened or dealt with work group compensation claims where the number of employees was misrepresented or that the jobs that they undertook was misrepresented. these frauds drive up the costs. one of the things that is
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interesting that pnc insurers are now seeing is how -- sorry -- is how -- is that all of these are evolving and as technology improves, so are the fraudsteres. consumers are increasingly wanting to buy their insurance policies from their mobile phones. have a claim through their smart phone. the question is how can they verify this? fortunately, this is where the industry is beginning to embrace innovations that will help improve delivery of their services to the u.s. consumer and reduce costs. as we're seeing so much of our lives, technology can help bring benefits to society. in this case by rooting out unwanted fraud. a report released last month outlined the fact that fraud -- the fact that insurers are
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recognizing their fraud fighting efforts and must adapt to the criminals and are finding that these efforts are actually creating quite optimistic results whether through data aggregation, verification, or analyzing the data and also using artificial intelligence and predictive analytics. they are knewizingneutralizing -- thank you again for the opportunity to speak before you today. i'm the director of government affairs in illinois.
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it's a national not for profit organization supported by 1,100 insurance companies who collectively write about 80% of the nation's insurance premiums. we investigate organized criminal groups that commit insurance fraud and vehicle crime. we have a history of established cooperation with federal, state and local law enforcement to help protect the american people from organized criminal rings.
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med care medicaid, and private health insurance. the hfpp is working to share data and investigations across all lines of insurance to better the tech fraud and assist law enforcement to root out potential criminal activities. dates back to our founding in 1912. stolen vehicles are profitable whether intact part of -- or illegally exported. regardless if they're shipped overseas or sold here in the u.s. these vehicles often don't know this they high -- buyers
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simple. oftentimes within a day or two and enstyes consumers in scams involving -- examples of inflating -- also prevalent as well as these folks collecting a down payment from people to do no work and then to leave town. we've worked with the commission commissioner you the for the opportunity to be here. pleased to answer questions at the appropriate time. welcome back. >> i appreciate the opportunity to provide testimony on consumer federation of america's
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perspectives on consumer fraud in america. cfa is concerned about fraud by the insurance agency against consumers. it's a serious problem. it costs consumers when they pay premiums for unrecess coverage, when they pay excessive rates for required coverage and buy insurance priced in an unfairly discriminatory manner and when they're presented with misleading policy language, they will never in fact receive. fraud by insurers also --
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if the industry can repair its image, that can positively impact the degree of fraud against it. however, siu and other attempts to control fraud must be reasonable. it should not go on for extensive periods while people are not able to return to their home, for example. in conclusion, cfa is concerned about insurance fraud. we're aware of numerous types of fraudulent activity by a few insurers and a few consumers --
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seeking claims payments. thank you. >> thank you very much. let me ask a few general questions and then i'll turn to the ranking member. maybe it's with you our states share opportunities for -- tornado, wind storm, hail most recently fires. where is the circumstance in which that fraud is likely to occur. thistlyly attended the national summit with several colleagues
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in the united states to talk specifically about natural catastrophes and what follows after that is unfortunately there's a high propensity for fraud and unfortunately most of the folks taking advantage of first we actually had the antifraud unit from the state of north carolina came and joined us because of the very specific job that they do. you have folks that go through these neighborhoods that are -- really prey upon suspecting consumer' but many times that's
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for some type of fraudulent activity that's where it crosses the line into the insurance issues no matter what state they're in. many times consumers are using that expense to have activity on their home in a major catastrophe, they're keeping receipts because all of those are applied towards that total insurance claim. so hopefully that answers your question but one of the things in moore, oklahoma that really is i think the bestial practice for the country is the registration of contractors that come into an area.
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there are some things that we've learned from communities around the united states that really have been best practices. >> perhaps for all of the panelists, the topic of fraud committed by the insurance company comes up. i think perhaps stereotypically we think of the consumer or third party as the perpetrator of fraud. do you see what she has described and do you take that seriously and are there effort as within the industry to make sure that the insurance companies and their employees their agents behave in a noncritical matter in an ethical way. >> absolutely. we absolutely do. we have the insurance
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these scams are perpetrated by rogue insurance adjusters and especially rogue insurance agents. at one time, insurers didn't do a good job in policing their own employees on this. they do want to make sure the consumers are protected and their own reputations are protect protected. in those areas, i think it's getting better but some of these other instances that you're looking at, i think you also have to distinguish between what is a bad practice on behalf of an insurance company that's harming consumers and what may be deemed criminal or civil fraud as defined in the state statutes. and i think we need remedies for
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both. but some may be abuse. some pay be outright fraud. >> i can see a difference between the frustration that comes with the slow payment for the check or the bureaucracy that comes with filing the claim, that's different i think, than outright fraud trying to deny the consumer their due. >> thank you very much. welcome to all of you. i want to talk about an issue that is of grave concern to connecticut and possibly all of the northeast and the country. it goes by name of puratite. few in this room would know how to spell it.
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it is well known in connecticut and massachusetts and other parts of the northeast. it -- pyrrhotite. it unfortunately has cost hundreds of connecticut homeowners possibly their life savings. hundreds of homes in connecticut mostly working and middle class families are reported to have cracking or crumbling foundations. those homes are quickly declining in value. some have approached the point of worthlessness. the only known solution is to replace the entire foundation. costs exceeding $150,000 each. p the theory is that this
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condition could spread to thousands of other homes whose foundations were also poured using concrete aggregate from a particular quarry that contains high levels of a naturally occurring mineral called pyrrhotite. insurers have been unwilling, they have been unwilling to provide desperately needed assistance to these homeowners. instead of alerting their customers about the risks once the insurers became aware of them they changed and updated the policies to strictly define the coverage of collapse to only, quote, abrupt collapse. and they added foundations to the list of policy exclusion.
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they never properly told their customers what they were doing. they never told them the reason they were doing it. they never adequately notified them. so the homeowners could take steps to protect themselves. either by rebuilding or taking construction precautions about the foundations or -- they immediately sought to protect themeses rather than their customers. i have highlighted the responsibility of insurers to do more. some have offered but most have refused to step up and honor their obligation to these
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homeowners and i am out of patience. there have been lawsuits. so far, i've declined to enter them but i think i and my colleagues and others are at the point of wanting more action and more compensation for these homeowners whose life savings are at risk, whose homes are not only crumbling but whose financial well being are crumbling as well. so when insurers become aware of a problem as they did here, don't they have an obligation to notify and inform their consumers as insurers failed to do here but they are literally
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changing their policies. it's a standard exclusion so it's not specific to connecticut. >> this issue is potentially widespread. >> i don't know -- we only know of this particular issue in connecticut. >> well, when i say the issue, i don't mean pyrrhotite, i mean changing policies so as to in effect exclude a problem that the insurers know is looming
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denied. i understand that something needs -- everybody wants there to be a solution but the solution and whether or not it was something intentional from the insurance companies. i'm not sure. isn't this precisely the -- everybody buys insurance in order to cover their risk. now, what we do is make sure that people understand how that insurance works because there are things that need to happen in terms of standard exclusions for defective construction materials. that is not a homeowner insurance policy issue. that may be a manufacturer construction issue but it's not one that falls to the personal homeowner insurance policy. >> i'm going to ask.
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exclude earthquakes but we're not going to properly inform consumers so they're going to wake up today as many of your fellow oklahomaens did with damage to homes and they're going to be told the policy is changed. it's only earthquakes in april in leap years. that's the equivalent of what happened here. it's the lack of proper notification. >> exactly. and as insurance commissioner and i would say this to our insurance commissioner, the insurers have an obligation to do better. >> no question. the disclosures whenever a product or a contract is changed, those disclosures, the clients, consumers should be educated on that. it's unfortunate though through
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the national -- and regulatory authority. some of these are changing but many of them are not read but if the folks are not getting the proper disclosures, i agree with you. >> well, i think we're all in agreement. in my view, there's no question that the disclosures were totally inadequate that this conduct is indefensible. i support efforts in the courts more vigorously than we have before because as i say, i have lost patience with fema, with other sources of recourse.
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tremendous floods. homeowners were really caught unawares. and life altering kinds of things unfortunately we lost two folks but how do you recommend going in working with ems and fema and sba to try to facilitate those make sure that rural americans are not going to be ripe for the opportunity i think one thing that's been done very well is provide consumer tools at the state level many of
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the states like mine have put together psas. for instance, we've put together a series of psas relative to earthquake, wild fire to be able to drive that message at a local level to understand the claims process process. those same principles apply because it is very challenging an i do agree. i've been to too many sites in my state where folks have been totally devastated and don't understand the claims process no matter what caused it. >> one thing i've noticed your
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first inclination in your home is to get everything out. you have to document every single thing. keep your receipts for your cleaning fluids. all the stuff and they give me blank looks. we try to encourage that in oklahoma with the number of catastrophes that we have. >> i think that's like i said that's a good suggestion. i'm going to go ask about the opoid issue on our state of west
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in some ways insurers can also be part of the problem. opoids and some insurers try to do the right thing by limiting the amount of opoids a person should be able to obtain but sometimes it's not done and other other much less safe alternative alternatives. so in these cases, this sort of turning to street drugs exacerbates the problem. >> i have just one second left.
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of health insurance and one of the things that comes to me in the testimony that i've heard from you is medical insurance fraud i would love to know information that you have in regard to the overall costs of the system that this kind of fraud let me ask mr. -- i think this is directed at least initially to you. there's a couple of things -- i'm going to ask you about your coalition 2016 annual report. there's also a study -- the state of it highlights the use
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of technology to combat insurance fraud. would you elaborate on the increasing use of vehicle tell mattics, drones, social media searchs. insurance company databases. the internet of things. the broad jurisdiction of our commerce committee has a lot to do with these things. i would like to hear how we can combat fraud and how you're
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doing. we had a meeting in december where a gentleman was charged with arson with burning down his home. he happened to have a pace maker implanted in his chest and the prosecutor got a court order to force him to sit so they could take the data off his pace maker which somewhat demonstrated what he said somewhat as far as the arson could not have happened and the court just ruled that at that data can be used in court and i think that's an extreme example we're seeing as far as use of data. we're going to see a lot of examples come forth and with that i think discussions as far as the privacy of americans and when is going too far even if it's looking at criminal fraud
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let me make a comment there. >> please. >> the naic has just formed an innovation task force which over the last several months, weaver been listening to the emerging technologies in all different areas that you highlighted. it's one of something that the regulators are -- cyber issues or the use of drones tell mattics, big data. we have a big data working group that many of the commissioners are involved does law
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enforcement have the tools necessary -- are they behind the curve in regard to this compared to the insurance industry? >> we partner with law enforcement on a regular basis. we make any of the tools available to us on the investigations no matter which way we're going back and forth. mr. lynch may have comments related to that but the regulators that through proper procedures are always embedded in my state as is the other states to provide assistance as a state agency to any law enforcement agency that may be seeking some of that data that
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discriminatory impact on pricing for some especially low income consumers. that needs to be taken into account as well. >> thank you very much. let me turn to the ranking member. >> thank you. i'm going to try to be as quick as possible but perhaps with the chairman's permission, i'm sure he's seen the 60 minutes piece on audits leading to life
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insurance companies being discovered to have uncovered a systemic industry wide practice of not paying beneficiaries who were unaware there was a policy. something that is not at all uncommon. the 60 minutes piece uncovered that insurers routinely use the social security death master file but only to their advantage to cut off annuity or retirement payments once the policy holder has died. when it came to life insurance would claim that they had no idea that a policy holder had died even worse, an insurer would continue to pay themselves life insurance premiums out of the dead policy holder's nest egg. to put it bluntly, the insurer put the burden on beneficiary to
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come forward but often the beneficiary had no idea that the policy existed. and the insurer used that ignorance to its benefit. they have acknowledged some of them have their responsibility and have settled litigation with some 35 still have not done so. when one of your colleagues was asked about this practice, he said he would release, quote the hounds of hell on these insurers because in effect they were failing to pay benefits to beneficiaries and that misconduct in my view was absolutely fraudulent. we're here about insurance fraud. i would like to ask you and mr. jay what you are doing to prevent this kind of fraud.
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but the naic is continuing to work on those settlements and commissioner mccarty is highly respected and commissioner at pier is the florida commissioner which has continueded to work on some of those activities. so it has our attention and we're remaining vigilant to make sure that those consumers get the moneys that are due them.
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>> for the record, about 35 insurance companies still have not settled in that case. >> right. >> we can provide you -- a really urgent issue. >> exactly. i would ask your permission to put together some information on an update to those 35 insurers and follow up on that particular item but i can tell you it's a high priority and we're for not
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>> through the process here i think one of the things that i would like to note about the lost life policy locater service is that once these policy benefits and we've had the opportunity to find these for the citizens of oklahoma, it's a very impressive chart in assisting consumers but when the national association of insurance commissioners to the best of my knowledge like in oklahoma when we find a beneficiary or match them up, there's no charge to them, no reduction in those fees and i believe that under some of the other circumstances through the treasurers departments in certain states that there is a fee redacted. in my opinion, that's the wrong
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thing to do. consumers should get 100% of the money owed them. >> i have one -- i have a couple more brief questions. >> to demonstrate my firmness but also my accomodation, the cloak room is so -- the floor is holding the vote an extra five minutes so if you can wrap up in five minutes, we'll both accomplish what we want to accomplish. >> this is bipartisan cooperation at work before your eyes in realtime. [laughter] >> i will have more questions froward. this area is very important to me. i want to commend the commissioner of florida and your colleagues who have joined in the task force as well as of course 60 minutes for exposing this fraud. i don't use that word lightly. it is a fraud. and exposure of it -- avoid this kind of fraud and you think --
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we're talking about life insurance. we're talking about insurance people buy in the expectation their sisters, brothers, children spouses rely on it to survive, to live and to reap the benefits of that life. a lengthy article in the "new york times" last year detailed a new and disturbing trend in the whole life industry. i'm sure you're aware of it. insurance companies have jacked up premiums on whole or universal life policies and shifted the burden of dividend payments from the insurance company to other policy holders. people who bought universal life policies in the 1980s and 90s, some of which guaranteed annual returns of 4% or more are seeing their premiums now soar. so the new rates have left many older americans with no chase but to drop coverage and lose,
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you guessed it, the entire value of his policy after years and years of investing in it. and i am raising this issue. i know we're not going to have final answers today but i want to ask realizing that many whole life policies were underwritten during a decade of high interest rates that could support more generous dividends. i also understand these insurance policies gave a guarantee and policy holders seem to have kept their side of the bargain. are these increases in premiums fair and justified or are they simply a way for insurance companies to reduce their liability and eliminate the most expensive policies. i understand they're expensive. but don't they have an obligation to do better? >> certainly it seems unfair to
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thanking you from the national association of insurance commissioners. the regulators. we believe that state based regulation is the best place for insurance, the closest place to the consumer. in my state we've been regulating insurance since state hood and my colleagues that i represent are very proud of the work they do protecting consumers. we appreciate the opportunity to be here. this is a very very timely topic and evolving topic relative to new trends and fraud. so thank you senators, for having us. >> if i may just make one concluding remark. i sat exactly where you are, i don't know whether it was five or six years ago on a panel actually i think i sat where mr. jay is now. and to my right was the attorney general of new york who argued that insurance regulation should
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be turned over to the federal government. it has been as you say quite correctly a state role and responsibility. i said no. insurance regulation should continue to be a state responsibility but i said that the states have an obligation to do better and be more rigorous in their oversight. i would hope we would work together and improve the eave pacy of that regulation. >> i appreciate the witnesses testifying and the record will remain open for two weeks for members to submit questions. i will have some. it appears the ranking member will. my guess is that other colleagues we would ask you to respond to those and, again, we thank you for your presence with us today. the committee is adjourned.
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