Company Complaint Information

Company Profile



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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
2022	129	60	49	20	34
2021	279	141	94	44	114
2020	494	263	166	65	204

Violation Study

The following table represents number and type of violations found, by reference to the line of insurance and law allegedly violated.

Year	Line of Coverage	Law	Section	Summarized Description of Law	# of Alleged Violations
2022	Disability	CCR	2695.7(b)(3)	Must notify claimant that claim denial can be reviewed by the California Department of Insurance.	1
2022	Disability	CIC	796.04	Rescission or modification of authorization to healthcare provider after services have been rendered	1
2022	Disability	CCR	2695.5(a)	Must respond to the California Department of Insurance within 21 calendar days.	6
2022	Disability	CCR	2240.1b6	Network providers available in network facilities	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	18
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	CCR	2694a6	Facts of the complaint merit remedial action	5
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	5
2022	Disability	CIC	880	Failure of insurer to use own name	10
2022	Disability	CCR	2694a2	In contravention of an approved rate filing(s)	1
2022	Disability	CCR	2695.7(d)	Insurer shall conduct a thorough, fair and objective investigation. Cannot seek unnecessary information from claimant.	1
2022	Disability	CCR	2695.6(b)	Licensees shall provide thorough and adequate training regarding the regulations to all their claims agents. Exception licensed at	1
2022	Disability	CIC	790.03h1	Misrepresenting facts or policy provisions.	4
2022	Disability	CIC	790.03h5	Not attempting to effectuate prompt, fair, & equitable settlement when liability clear.	5
2022	Disability	CIC	10169i	Must prominently display information concerning the right of the insured to request an independent medical review	4

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	.118	.00	.00

If complaint data does not appear for this company, this link will provide you with an explanation.