Company Complaint Information
| , | |||
| 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 | 180 | 106 | 39 | 35 | 76 |
| 2021 | 137 | 86 | 26 | 25 | 77 |
| 2020 | 150 | 88 | 34 | 28 | 79 |
| Violation Study |
| Year | Line of Coverage | Law | Section | Summarized Description of Law | # of Alleged Violations |
|---|---|---|---|---|---|
| 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 | 36 |
| 2022 | Disability | CIC | 790.03h5 | Not attempting to effectuate prompt, fair, & equitable settlement when liability clear. | 20 |
| 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 | 2 |
| 2022 | Disability | CCR | 2694a6 | Facts of the complaint merit remedial action | 16 |
| 2022 | Disability | CIC | 790.03h2 | Failing to acknowledge and act promptly upon communications. | 1 |
| 2022 | Disability | CIC | 790.03h3 | Failing to adopt & implement standards for the prompt investigation & processing of claims | 13 |
| 2022 | Disability | CIC | 880 | Failure of insurer to use own name | 16 |
| 2022 | Disability | CCR | 2694a3 | In contravention of own rules, policies, procedures, guidelines | 1 |
| 2022 | Disability | CCR | 2695.11(d) | Life and Disability insurer shall affirm or deny within 30 calendar days from original notification - see CIC Section 10123.13. | 2 |
| 2022 | Disability | CIC | 790.03h1 | Misrepresenting facts or policy provisions. | 2 |
| 2022 | Disability | CCR | 2695.7(b)(1) | Must deny all claims in writing. Must cite statute, applicable law or policy provision on 1st party claims. | 1 |
| 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 | 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 | 2695.3(b)(2) | Must record in the file the date the licensee received, processed, and/or transmitted or mailed all relevant documents. | 1 |
| 2022 | Disability | CCR | 2695.5(a) | Must respond to the California Department of Insurance within 21 calendar days. | 12 |
| 2022 | Disability | CCR | 2240.1b6 | Network providers available in network facilities | 1 |
| 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. | 2 |
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.
Copyright © California Department of Insurance
