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
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.