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 |
| 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.
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