HIC identifies problems at local insurance company

| 16/01/2023 | 50 Comments
Cayman First at Countryside, Savannah

(CNS): The Health Insurance Commission (HIC), in consultation with the Cayman Islands Monetary Authority (CIMA), conducted an investigation last year of the local insurance company Cayman First Insurance following complaints about its failure to pay legitimate claims to healthcare providers. During the investigation, the regulator found a number of problems at Cayman First, including a staff shortage and problems with a new claims system. As a result, the HIC said it had imposed a series of conditions on CFI, which the insurer must comply with to maintain its Approved Insurer Certificate. 

In a statement issued on Friday, the HIC said it had been in contact with CFI senior leadership (president and VP) via weekly phone calls, regular exchanges of emails and frequent updates. It also conducted a site visit to the CFI office.

“CFI senior leadership has assured the HIC that these issues are being addressed, but that they will require some time for complete resolution of the challenges,” the HIC said. “Even though the HIC recognises the efforts which CFI has made in working to rectify the situation, the HIC has, nonetheless, imposed a series of conditions on CFI with which the insurer must comply.”

This includes the production of its quarterly financial reports for the year 2022, a written mitigation plan for the system integration and restoring appropriate staffing levels, monthly reports for historic (over 30 days) and current outstanding claims, and a timeline for the clearance of identified backlogs. The company must also provide the HIC with a complaints-handling policy.

CFI was expected to provide an update to the HIC today. The commission will also be ensuring the insurer provides stakeholders with more regular updates on adherence to the conditions and monitoring its progress to resolve the issues as a matter of public interest.

Although the HIC received only one informal complaint from a registered healthcare provider, the commission said there were other indications in the public domain that a number of providers had been impacted by non-payment of claims. Under the Health Insurance Regulations, insurance companies that fail to pay undisputed claims within 30 days are liable to pay interest on the money owed from the 31st day after the claim has been submitted to the date on which payment is made to the health practitioner.

Cayman First denied having any significant problems in a statement issued in November. The company said that rumours were circulating in the market regarding the financial health and stability of CFI and any concerns about its “operations and outlook are completely unfounded”.

CFI said it had paid claims totalling millions of dollars each year and its financial strength was affirmed in 2022 as A- (Excellent) with a stable outlook by rating agency AM Best. But it also said it had recently made a significant investment in a new system implementation that had presented some “initial hurdles that appeared during the first phase of our rollout” and it was “working diligently to transition to full functionality as soon as possible”.

Cayman First claims that payments continue to be processed for all providers and that providers had confirmed they were accepting member ID cards. However, a number of long-serving employees have resigned recently and others have been fired, and CFI admitted that there were some staffing issues.

“As is the case in the business world, companies may find that there are different views among the leadership on how to evolve various aspects of the business and may agree to part ways with team members,” CFI said in the statement, adding that it continued “to advance our people as we welcome new leaders to our team”.

Registered healthcare providers and clients impacted by non-payment of claims or other concerns are encouraged to file a formal complaint or contact the HIC by emailing hic@gov.ky or calling 946- 2084.

The HIC office is located at the Government Administration Building.

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Category: Health, Health Insurance

Comments (50)

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  1. Anonymous says:

    Since it seems that health care providers are not making complaints, I have a suggestion: Every patient who has had their insurance card refused by a health care provider and has had to pay up front for care should make a complaint every time it happens. Registered healthcare providers and clients impacted by non-payment of claims or other concerns are encouraged to file a formal complaint or contact the HIC by emailing hic@gov.ky or calling 946- 2084.

  2. Anon says:

    The worst of this is that it affects the poorest in our community. I’m sure CIMA/HIC/government do not appreciate this. But we are only as good as the poorest of our communities.

    I’m glad I have my helper with another insurance provider, because we should all be able to get health care as soon as possible when needed. I’m lucky that my employer pays full coverage, but most of those insured with Cayman First are domestic helpers and people that can’t be insured through a plan, which means that they will be affected when they can’t pay to see the doctor, because the provider won’t accept the insurance.

    Not ok.

  3. Anonymous says:

    An FATF headline waiting to happen.

  4. Anonymous says:

    Where is CIMA in all of this? Sounds like only the HIC is taking action.

  5. Anonymous says:

    I do not think CF is being transparent with its customers. I went to the doctor and had to pay upfront, and the doctor disclosed why they refused my insurance card. Things are much worse than they are letting on. I moved my policy and am quite happy with my new insurer.

  6. Anonymous says:

    Mmmm, don’t know if it’s the best of ideas to give this company MORE things to do. It seems they can barely do the job we are paying them to do, let alone do with CIMA wants them to do.

    Oh wait, CIMA is important we, the customers, are not.
    Guess I’ll have to wait for my re-reimbursement a few more months.

  7. Anonymous says:

    All insurance is becoming a problem now. We tried to move our home insurance away from this company before Christmas when they quoted an unbelieveable premium increase, but found the other local insurers were all up to their quotas for the year and weren’t taking on any new business. So we were forced to renew the policy we already have. When there is no choice in the market, the insurers can charge what they like and your choice is pay it or be uninsured.

    • Anonymous says:

      Or you can pay the premium and find out you were uninsured anyway when the insurer turns out not to gmhave adequate reinsurance or simply goes bust.

      • Anonymous says:

        Weeks after Ivan, I recall joining a single file line, fifty people deep, to surrender plates and ownership docs on vehicles for $0.20 on the insured dollar – for comprehensive replacement value policies at one of the island’s biggest insurance companies. Call the Indies Suites owners and see how they are doing.

  8. Anonymous says:

    Cayman = ( Struggling….)

  9. Anonymous says:

    They shouldn’t be allowed any more time…our entire company is insured by these fools who jacked up our rates 20% this year and now providers are NOT taking the insurance cards at all. Everyone paying out of pocket for everything. Completely inexcusable and something needs to be done.
    But also I’m very concerned that this is so bad and only ONE provider has complained and only informally? Wtf…you’re all not getting paid you should all have complained formally!!!

    • Anonymous says:

      Registered healthcare providers and clients impacted by non-payment of claims or other concerns are encouraged to file a formal complaint or contact the HIC by emailing hic@gov.ky or calling 946- 2084.

      Have your entire team email!

  10. Anonymous says:

    Maybe they need to look at why there was only one informal complaint if there were widespread ongoing issues. Is the complaint process simple and easy to use and understand, and more importantly, without repercussion?

  11. Anonymous says:

    Did the HIC inquiry also consider why CFI premiums have to be paid at a strange little third party location on Shedden Rd.?

  12. Anonymous says:

    I set up Cayman First for my business. What an absolute horrible experience. I think they actually worked at making things worse. Completely awful company, full of people with horrible attitudes. Problem definitely starts from the top. The issue is that have with the article is that they claim they only have one complaint. That lie is so wrong, that I think you should all walk away. No run away.

  13. Rodney Barnett says:

    If anyone is looking to the Cayman Islands Monetary Authority (CIMA) to protect providers and claimants, for protection — forget it.

    Three years ago, my retirement fund consisting of assets from my 401K account, was deposited through OneTradeEx (OTX) to an American Mutual Fund. There were no problems with my account, nor the accounts for ANY of OneTradeEx’s customers. All of the funds were individually segregated accounts of the account holder.

    However, even with no illegal actions by 1TX, CIMA allowed their former employee, now a local liquidator, to drain all account holders’ assets down to zero, citing administrative costs to adjudicate the provisional liquidation of OTX.

    The Cayman Islands Courts sided with the liquidator, referencing an obscure law called Berkeley Applegate, even though all financial institutions invoiced indicated the accounts were segregated.

    CIMA raised no objections to any of the Court’s rulings causing many account holders to lose their entire life’s savings and others to lose as much as one million dollars.

    So, don’t count on CIMA to protect your health insurance policies or claims.

    • Andrea says:

      Don’t count on CIMA to protect homeowners from thieving banks either. To this day I can’t find in CIMA Policies their Directives to banks on default loans over 180 days being written off. Thus allowing banks to recoup their losses from Loan Loss Insurance which the customer pays a premium of up to $4,000 per annum by it being added to the customer’s loan principal !!!

    • Billy Gates says:

      No one should have any money in any financial institution that is regulated or licensed by CIMA.
      What they did to the Onetradex clients was an example of NOT looking out for the clients but to line the pockets of Lawyers and insolvency practitioner’s. At least in Canada, UK and the US you have consumer protection agencies.
      I live in Cayman and don’t leave any of my retirement investments in Cayman. If Butterfield etc go under… you are screwed!!!!

    • JTB says:

      Berkeley Applegate isn’t remotely ‘obscure’

  14. anon says:

    There is also a significant problem with medical service providers. Both myself and my wife have been overcharged for co-payments by several providers who then receive more than their claim but fail to refund the difference.

  15. Anonymous says:

    It sounds like there is a possibility that the leadership of the company terminated the competent staff members in favor of nepotism and incompetence. I don’t buy this excuse about system issues. Who was responsible for the implementation of this new system that is creating so many problems and what type of executive oversight was in place during the project. It sounds to me like some executive heads need to be held accountable.

  16. Anonymous says:

    I was wondering why the long-time Brac agent got out of the insurance business – now I have a better idea.

    Sounds like the new leadership is the problem – dont want to fully staff the company and not dedicating the time and resources to get new claims system up to speed. And whether senior leadership is the actual problem or not – when you are in charge it is your responsibility – period – end of statement.

  17. Anonymous says:

    Still waiting for them to payout damage done to my car. This needs to be investigated as well.

    • Anon says:

      I had a similar situation. I could not have been more angry given the situation. It’s bad enough when you are involved in an accident. Another thing when you the other insured is with Cayman First, because they delay everything and sometimes don’t even pay then. They provide the cheapest insurance and then don’t want to pay out.
      I have my domestic helper with Vanguard Risk and they seem to be much better.

  18. Anonymous says:

    Time for the government to open up the insurance market and allow us to use overseas insurers. We have an international policy that is a third of the cost and provides 3 days claims turnaround, $400 deductable, and no co-pay. Plus much greater benefit payouts. And yet still the law requires us to pay for the SHIC as well even though it barely covers anything and costs a fortune!

  19. Anonymous says:

    Lot of concern for providers, but what about policy holders? Had to submit claim because optician refuse to accept CF. Six weeks now and zip response.

    Should I pay next invoice?

  20. Anonymous says:

    wow, they insure my family and this is making us look to move.

  21. Anonymous says:

    Next they should look in to the providers billing the client then waiting until the end of the year and billing the insurance companies for same. Its a real scam.

  22. Anonymous says:

    Insurance companies AKA scum of the earth! Happy to collect $$ but like getting blood out of a stone when you actually need them.

    • Anonymous says:

      Caymanians LOVE to accept their incorporation fees and annual fees. Karma sucks Cayman!

    • Anonymous says:

      Unfortunately, true.

    • Anonymous says:

      It is the only form of extortion that is legal

    • WorkTogether says:

      Insurance is like betting against yourself, and hoping you lose the bet.

      We are an elderly couple who has been with this company through its various iterations. We paid and paid for decades without a claim. You would not beLIVE what we are forced to pay now that we have a claim or two.

      To their credit, I understand that all or nearly all of the local insurance corporations are also struggling, and just hoping to not garner notice.

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