Company Complaint Information
| BLUE SHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY | |||
| 601 12TH STREET | |||
| OAKLAND, CA 94607 | |||
| 888-800-2742 | |||
| 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 |
|---|---|---|---|---|---|
| 2022 | 76 | 27 | 31 | 18 | 23 |
| 2021 | 68 | 31 | 22 | 15 | 27 |
| 2020 | 64 | 22 | 32 | 10 | 12 |
| Violation Study |
| Year | Line of Coverage | Law | Section | Summarized Description of Law | # of Alleged Violations |
|---|---|---|---|---|---|
| 2022 | Disability | CIC | 880 | Failure of insurer to use own name | 10 |
| 2022 | Disability | CIC | 10123.137c | Provider disputes must be in writing and determination must be made within 45 days | 1 |
| 2022 | Disability | CIC | 10123.13b | For uncontested claims not paid within 30 days interest is due at 10% per year. | 1 |
| 2022 | Disability | CIC | 10169i | Must prominently display information concerning the right of the insured to request an independent medical review | 4 |
| 2022 | Disability | CCR | 2695.3(a) | File must contain all documents. | 1 |
| 2022 | Disability | CIC | 790.03h5 | Not attempting to effectuate prompt, fair, & equitable settlement when liability clear. | 2 |
| 2022 | Disability | CCR | 2695.5(a) | Must respond to the California Department of Insurance within 21 calendar days. | 5 |
| 2022 | Disability | CCR | 2695.5(b) | Must provide complete response to claimant inquiries within 15 calendar days. | 1 |
| 2022 | Disability | CIC | 790.03h1 | Misrepresenting facts or policy provisions. | 5 |
| 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 | 14 |
| 2022 | Disability | CIC | 790.03h3 | Failing to adopt & implement standards for the prompt investigation & processing of claims | 6 |
| 2022 | Disability | CIC | 10169m | If a disposition of the grievance denies/modifies/delays health care, statutory info & forms shall be provided to the insured | 1 |
| 2022 | Disability | CCR | 2694a3 | In contravention of own rules, policies, procedures, guidelines | 1 |
| 2022 | Life/Annuity | CCR | 2695.5(a) | Must respond to the California Department of Insurance within 21 calendar days. | 1 |
| 2022 | Life/Annuity | CCR | 2694a5 | Failed to respond or did not provide a complete response | 1 |
| 2022 | Life/Annuity | CIC | 10113.72b | Company must provide annual notice of right to designate person(s) to receive lapse notices | 1 |
| 2022 | Life/Annuity | CIC | 10192 | Paid up nonforfeiture benefits; notice to policy owners / beneficiaries | 1 |
| 2022 | Life/Annuity | CIC | 10113.71 | 60 day grace period notice must be sent to policyholder, named designee, for unpaid premium | 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 |
|---|---|---|---|---|---|
| 2022 | Group Life | .00 | .259 | .00 | .00 |
If complaint data does not appear for this company, this link will provide you with an explanation.
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