Company Profile
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
2020 150 88 34 28 79
2019 164 80 44 40 94
2018 165 60 55 50 83

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
2020 Disability CIC 10123.88c California health policy must cover "reconstructive surgery" as defined 1
2020 Disability CIC 10123.137c Provider disputes must be in writing and determination must be made within 45 days 1
2020 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
2020 Disability CIC 10123.147a Emergency services claim must be paid, contested or denied within 30 working days by written notice with required language 2
2020 Disability CCR 2694a6 Facts of the complaint merit remedial action 25
2020 Disability CIC 790.03h3 Failing to adopt & implement standards for the prompt investigation & processing of claims 7
2020 Disability CIC 880 Failure of insurer to use own name 18
2020 Disability CIC 10123.13b For uncontested claims not paid within 30 days interest is due at 10% per year. 1
2020 Disability CIC 10169m If a disposition of the grievance denies/modifies/delays health care, statutory info & forms shall be provided to the insured 1
2020 Disability CCR 2695.7d Insurer shall conduct a thorough, fair and objective investigation. Cannot seek unnecessary information from claimant. 1
2020 Disability CCR 2695.11d Life and Disability insurer shall affirm or deny within 30 calendar days from original notification - see CIC Section 10123.13. 1
2020 Disability CIC 790.03h1 Misrepresenting facts or policy provisions. 6
2020 Disability CIC 10169i Must prominently display information concerning the right of the insured to request an independent medical review 12
2020 Disability CCR 2695.5b Must provide complete response to claimant inquiries within 15 calendar days. 2
2020 Disability CCR 2695.5a Must respond to the California Department of Insurance within 21 calendar days. 6
2020 Disability CIC 790.03h5 Not attempting to effectuate prompt, fair, & equitable settlement when liability clear. 7
2020 Disability CIC 10169n1A Provide the IMRO a complete copy of the claim file in 3 business days of DOI notice. 1
2020 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 39

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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