Vermont Department of Insurance Settles with Acadia Over Improper Handling of 1st Responder PTSC Claims

The DFR reached a $100,000 settlement with the insurer

Acadia Insurance Company has entered into a settlement agreement with the Vermont Department of Financial Regulation (DFR) in which the company will pay an administrative penalty of $85,000 and contribute $15,000 to the Vermont Financial Services Education and Victim Restitution Special Fund.

“Our first responders regularly face extraordinarily challenging situations as they work to keep our communities safe, and as a result, they experience unique impacts to their mental health,” said DFR Commissioner Michael S. Pieciak. “It is critical for our first responders to receive necessary and deserved mental health care and this settlement will help ensure these illegal claims practices do not occur again as a result of the corrective actions the company is required to undertake.”

According to the DFR, the settlement relates to the improper handling of Vermont workers’ compensation claims, including those filed by first responders for posttraumatic stress disorder (PTSD), by Acadia’s third-party administrator W.R. Berkley Corporation (BerkleyNet). DFR’s review of Vermont workers’ compensation claims handled by Acadia between 2015 and 2019 showed that BerkleyNet engaged in unfair claim settlement practices and violated Vermont’s Insurance Trade Practices Act in a vast majority of the claims it handled in Vermont involving PTSD.

BerkleyNet refused to pay claims without conducting a reasonable investigation or engaging in a good faith attempt at settlement. In one of the most egregious examples, BerkleyNet mailed a request to a first responder for information necessary to process the workers’ compensation claim and denied the claim on the very same day. These aggressive claims adjustment and settlement practices deterred first responders who may have been experiencing PTSD due to work related stress from pursuing claims.

The $15,000 contribution to the fund will be used to support educational efforts for the first responder community.

Source: Vermont Department of Financial Regulation

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