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 |
|---|---|---|---|---|---|
| 2024 | 368 | 211 | 70 | 87 | 236 |
| 2023 | 294 | 161 | 85 | 48 | 155 |
| 2022 | 225 | 114 | 61 | 50 | 117 |
| Violation Study |
| Year | Line of Coverage | Law | Section | Summarized Description of Law | # of Alleged Violations |
|---|---|---|---|---|---|
| 2024 | Disability | CIC | 10126.66(a)(2) | At the time of payment the insurer shall inform the insured and the noncontracting provider of the in-network cost-sharing amount owed by the insured. | 10 |
| 2024 | Disability | CIC | 10126.66(a)(1) | The insured shall pay no more than the in-network cost-sharing amount to a non-contracting ambulance provider | 21 |
| 2024 | Disability | CIC | 10112.2 | Compliance with Affordable Care Act (PPACA) | 1 |
| 2024 | 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 |
| 2024 | Disability | CIC | 10123.147a | Emergency services claim must be paid, contested or denied within 30 working days by written notice with required language | 4 |
| 2024 | Disability | CCR | 2694a6 | Facts of the complaint merit remedial action | 63 |
| 2024 | Disability | CCR | 2694a5 | Failed to respond or did not provide a complete response | 2 |
| 2024 | Disability | CIC | 790.03h2 | Failing to acknowledge and act promptly upon communications. | 29 |
| 2024 | Disability | CIC | 790.03h3 | Failing to adopt & implement standards for the prompt investigation & processing of claims | 20 |
| 2024 | Disability | CIC | 880 | Failure of insurer to use own name | 14 |
| 2024 | Disability | CCR | 2695.3(a) | File must contain all documents. | 20 |
| 2024 | Disability | CIC | 10169m | If a disposition of the grievance denies/modifies/delays health care, statutory info & forms shall be provided to the insured | 1 |
| 2024 | Disability | CIC | 10126.66(d) | Insurer shall reimburse a noncontracting ambulance provider the difference between IN cost sharing amt & the rate established by a local govt or the reasonable and customary value. | 53 |
| 2024 | Disability | CIC | 790.03h1 | Misrepresenting facts or policy provisions. | 10 |
| 2024 | Disability | CCR | 2695.7(b)(3) | Must notify claimant that claim denial can be reviewed by the California Department of Insurance. | 1 |
| 2024 | Disability | CIC | 10169i | Must prominently display information concerning the right of the insured to request an independent medical review | 83 |
| 2024 | Disability | CCR | 2695.5(b) | Must provide complete response to claimant inquiries within 15 calendar days. | 2 |
| 2024 | Disability | CCR | 2695.5(a) | Must respond to the California Department of Insurance within 21 calendar days. | 90 |
| 2024 | Disability | CCR | 2240.1e | Network Adequacy-In-network benefit level for out of network provider if inadequate network | 1 |
| 2024 | Disability | CIC | 790.03h5 | Not attempting to effectuate prompt, fair, & equitable settlement when liability clear. | 10 |
| 2024 | Disability | CIC | 10169.1 | Provide the IMRO all records within 24 hours of DOI notice when imminent health threat | 1 |
| 2024 | Disability | CIC | 10123.137c | Provider disputes must be in writing and determination must be made within 45 days | 1 |
| 2024 | Disability | CIC | 10123.13 | Reimbursement of claims, time | 3 |
| 2024 | Disability | CIC | 10112.81(d) | The decision obtained through the IDRP shall be binding on both parties and the insurer shall implement the decision obtained through the IDRP. | 1 |
| 2024 | 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 | 51 |
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 |
|---|
If complaint data does not appear for this company, this link will provide you with an explanation.
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