Company Complaint Information
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Company Performance | |||
In compliance with California Insurance Code § 12921.1, the California Department of Insurance conducted a Consumer Complaint Study of all admitted insurance carriers. The company performance table provides the complaints determined by the department to require that corrective action be taken against the insurer, or leading to insurer compromise, or other remedy for the complainant, those that are found to be without merit, those with other outcomes, and justified complaints. Justified complaints often require additional review, as violations of California insurance laws may exist. |
Year | Closed Complaints (TOTAL of Categories 1-3) |
Category 1: Complaints found to require corrective action, leading to insurer compromise, or other remedy for the complainant. |
Category 2: Complaints found to be without Merit. |
Category 3: Complaints with Other Outcomes |
Category 4: Justified Complaints |
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2022 | 359 | 236 | 99 | 24 | 147 |
2021 | 350 | 239 | 79 | 32 | 154 |
2020 | 494 | 311 | 138 | 45 | 219 |
Violation Study |
Year | Line of Coverage | Law | Section | Summarized Description of Law | # of Alleged Violations |
---|---|---|---|---|---|
2022 | Disability | CIC | 10123.13b | For uncontested claims not paid within 30 days interest is due at 10% per year. | 2 |
2022 | Disability | CIC | 790.03h5 | Not attempting to effectuate prompt, fair, & equitable settlement when liability clear. | 25 |
2022 | Disability | CIC | 790.03h1 | Misrepresenting facts or policy provisions. | 25 |
2022 | Disability | CIC | 10169i | Must prominently display information concerning the right of the insured to request an independent medical review | 5 |
2022 | Disability | CCR | 2695.5(b) | Must provide complete response to claimant inquiries within 15 calendar days. | 4 |
2022 | Disability | CCR | 2695.5(a) | Must respond to the California Department of Insurance within 21 calendar days. | 11 |
2022 | Disability | CIC | 10169 | The insurer shall allow for an independent medical review for insured grievances involving disputed healthcare services | 1 |
2022 | Disability | CIC | 10123.13a | Claim must be paid, contested, or denied in 30 days to insured and provider. If contested written notice must contain DOI language | 60 |
2022 | Disability | CIC | 10123.13c | Contested claims become payable in 30 days or interest at 10% per year is due, after receipt of all required information. | 1 |
2022 | Disability | CIC | 10123.147e | Contested emergency service claim requesting additional information must be paid within 30 days of receipt or penalty applies | 1 |
2022 | Disability | CIC | 10123.135h4 | Decisions to approve, deny, delay or modify services must be in writing and communicated as prescribed | 1 |
2022 | Disability | CIC | 10123.147b | Emergency services claim is unpaid, uncontested or not denied within timeframe must contain penalty when paid | 1 |
2022 | Disability | CIC | 10123.147a | Emergency services claim must be paid, contested or denied within 30 working days by written notice with required language | 8 |
2022 | Disability | CCR | 2694a6 | Facts of the complaint merit remedial action | 29 |
2022 | Disability | CCR | 2694a5 | Failed to respond or did not provide a complete response | 2 |
2022 | Disability | CIC | 790.03h3 | Failing to adopt & implement standards for the prompt investigation & processing of claims | 46 |
2022 | Disability | CCR | 2694a3 | In contravention of own rules, policies, procedures, guidelines | 11 |
2022 | Disability | CIC | 880 | Failure of insurer to use own name | 15 |
2022 | Life/Annuity | CIC | 790.03h3 | Failing to adopt & implement standards for the prompt investigation & processing of claims | 1 |
If complaint data does not appear for this company, this link will provide you with an explanation.
To view the California Insurance Code (CIC), Click here
To view the California Code of Regulations (CCR), Click here
Comparison Data |
The information below is for complaints closed during the study period for this insurance company. The table provides the Justified Complaint Ratio, Market Share, Complaint Share, and Index for this company, grouped by the line of coverage the company was authorized to sell in this study period.
Year | Line of Coverage | JustifiedComplaint Ratio | Market Share | Complaint Share | Index |
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If complaint data does not appear for this company, this link will provide you with an explanation.
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