Company Profile
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 204 105 59 40 88
2023 175 93 56 26 60
2022 180 106 39 35 76

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
2024 Disability CCR 2240.6(c) An insurer shall maintain accurate provider directories for its networks. 1
2024 Disability CCR 2695.11(b) With each life and disability insurance claim payment the insurer shall provide to the claimant and assignee an EOB 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 1
2024 Disability CCR 2694a6 Facts of the complaint merit remedial action 8
2024 Disability CIC 790.03h2 Failing to acknowledge and act promptly upon communications. 8
2024 Disability CIC 790.03h3 Failing to adopt & implement standards for the prompt investigation & processing of claims 23
2024 Disability CIC 880 Failure of insurer to use own name 25
2024 Disability CIC 10144.5 Failure to cover diagnosis and medically necessary treatment for severe mental illnesses 1
2024 Disability CIC 10273.6e Failure to file a withdrawal of an individual health plan from the market and offer transfer to any other health plans w/o EOI 1
2024 Disability CCR 2695.3(a) File must contain all documents. 2
2024 Disability CIC 10123.13b For uncontested claims not paid within 30 days interest is due at 10% per year. 2
2024 Disability CCR 2694a3 In contravention of own rules, policies, procedures, guidelines 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. 2
2024 Disability CIC 790.03h1 Misrepresenting facts or policy provisions. 6
2024 Disability CCR 2695.7(b)(3) Must notify claimant that claim denial can be reviewed by the California Department of Insurance. 2
2024 Disability CIC 10169i Must prominently display information concerning the right of the insured to request an independent medical review 7
2024 Disability CCR 2695.5(b) Must provide complete response to claimant inquiries within 15 calendar days. 3
2024 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. 3
2024 Disability CCR 2695.5(a) Must respond to the California Department of Insurance within 21 calendar days. 25
2024 Disability CIC 790.03h5 Not attempting to effectuate prompt, fair, & equitable settlement when liability clear. 10
2024 Disability CIC 10123.13 Reimbursement of claims, time 3
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 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 50

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.


Last Revised - December 03, 2007 11:57 AM
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