August 14, 2003
VIA fax @ 808-586-2806
Mr. J. P. Schmidt, Insurance Commissioner
State of Hawaii
P.O. Box 3614
Honolulu, HI 96811-3614
RE: Complaint Against P&C Insurance Company, Inc. - Unfair Claims Practices
Claim: Mary Lou Woo, Trustee v. Bobby N. Harmon - 74 166 00491 03 JUSC
Date Claim Reported: May 27, 2003
Dear Commissioner:
I am enclosing a copy a letter dated August 11, 2003, from Matt A. Tsukazaki, of the law firm of TORKILDSON, KATZ, FONSECA, JAFFE, MOORE & HETHERINGTON. This is the latest in a series of declination letters, the first of which was sent by Clyde Mark, President of P&C Insurance Company, Inc. Copies of these prior letters have been previously sent to you.
According to the latest insurance regulations that I have available to me, the following acts constitute UNFAIR CLAIM SETTLEMENT PRACTICES:
“... misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue; failing to respond with reasonable promptness, in no case more than fifteen working days, to communications with respect to claims arising under its policies ... refusing to pay claims without conducting a reasonable investigation; not attempting in good faith to effectuate prompt, fair, and equitable settlements of claims; compelling insureds to institute litigation to recover amounts due under an insurance policy recovered in actions brought by the insureds....”
The following is a brief chronology of the submission of my claim ...
On May 27, 2003, l submitted my first Notice of Claim to P&C Insurance Company, Inc., c/o Aon Insurance Managers, Attn: Jill Miura. In this letter I stated the following:
“This is to tender defense of the above claim to P&C Insurance Company, Inc., as provided for in the Indemnification Agreement afforded to officers and directors of the company.
“Please have the company’s Claims Administrator contact me as soon as possible for further details and a copy of the Complaint.”
The authorized, third-party Claims Administrator for P&C Insurance, which I believe to be John Mullen & Co., Inc., still has not provided a response to this claim. I consider this to violate the rule of failing to respond with reasonable promptness, in no case more than fifteen working days, to communications with respect to claims arising under its policies....
2) On June 16, 2003, I sent a follow-up request to P&C, c/o Aon Insurance Managers, again requesting that P&C’s Claims Administrator contact me. In a letter dated June 20, 2003, Clyde Mark, President, P&C Insurance Company, Inc., wrote a letter rejecting my tender of defense. This rejection was made without requesting any additional information or even a copy of the Complaint. This would appear to violate the rule of refusing to pay claims without conducting a reasonable investigation.
3) On June 30, 2003, I replied to Mr. Mark’s rejection letter of June 16th, and noted the following discrepancies:
“First, you do not provide the names, or give policy numbers and policy periods, for those insurance companies on whose behalf you are denying coverages. Therefore, as mentioned previously, I must demand complete copies of ALL policies for which you denying my tender of defense.
“Second, I question if you have been authorized by all the insurance companies which issued these “past or current” policies to act on their behalf as Claims Administrator. I find it highly unusual for the President of an insurance company to personally deny coverages. In the case of P&C, I have first-hand knowledge that P&C contracts out its Claims Administration to an independent adjuster – which in the past has been John Mullen & Co. Could you please explain why this case is not being handled through an independent adjuster, and would you please forward me copies of any and all claims authorization documents from those insurance companies on whose behalf you have acted to reject my tender of defense.
“Third, as I stated in my letter of May 27, 2003, my tender of defense is based upon the Indemnification Agreement afforded by P&C to all officers and directors of the company. Therefore, your review of this tender should be based on the Indemnification Agreement in this contract with P&C – not the Indemnification Agreement contained in the Settlement Agreement. In order to further pursue this issue, I ask that you please review the indemnification provisions in the contract that I originally signed as president of P&C, and that you send me a complete, signed copy of this Agreement for my review in preparation for the Arbitration proceedings.”
“You categorize my submission of claims as ‘harassment of Kamehameha Schools and P&C Insurance.’ You use threats and intimidations to prevent my tendering defense of a claim to an insurance company that has Directors & Officers Liability insurance coverages for my protection. You are demanding that I must report claims or tender defense to your office and to your attention, and not directly to the insurance company. You are saying that it is not necessary for you to provide an Attorney of Record letter or other documentation to prove that you are actually authorized to act on the behalf of these entities. You will not divulge who P&C’s independent Claims Administrator is in this case - the person to whom you are supposed to be reporting. You claim it is permissible for you, on behalf of P&C, not to respond to any of my claims if you choose not to do so. Finally, you have denied my tender of defense on behalf of P&C even before I have presented my case....
www.the-catbird-seat.net/HI-Ins-Comm-8-14-3.htm
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For more, GO TO > > > More Claims By Harmon: P&C Insurance Company