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
2020 494 311 138 45 219
2019 1003 673 216 114 334
2018 971 589 285 97 470

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 10123.13a Claim must be paid, contested, or denied in 30 days to insured and provider. If contested written notice must contain DOI language 119
2020 Disability CIC 10123.13 Reimbursement of claims, time 1
2020 Disability CIC 10123.147e Contested emergency service claim requesting additional information must be paid within 30 days of receipt or penalty applies 2
2020 Disability CIC 10123.147b Emergency services claim is unpaid, uncontested or not denied within timeframe must contain penalty when paid 3
2020 Disability CIC 10123.147a Emergency services claim must be paid, contested or denied within 30 working days by written notice with required language 12
2020 Disability CCR 2694a6 Facts of the complaint merit remedial action 20
2020 Disability CIC 790.03h2 Failing to acknowledge and act promptly upon communications. 1
2020 Disability CIC 790.03h3 Failing to adopt & implement standards for the prompt investigation & processing of claims 106
2020 Disability CIC 880 Failure of insurer to use own name 25
2020 Disability CCR 2695.3a File must contain all documents. 1
2020 Disability CIC 10123.13b For uncontested claims not paid within 30 days interest is due at 10% per year. 4
2020 Disability CCR 2694a3 In contravention of own rules, policies, procedures, guidelines 6
2020 Disability CIC 10133.66b Insurer cannot request overpayment of claim unless written request for reimbursement is sent with 1 yr; not for fraud 1
2020 Disability CCR 2695.6b Licensees shall provide thorough and adequate training to claim handlers except attorneys. 1
2020 Disability CIC 790.03h1 Misrepresenting facts or policy provisions. 46
2020 Disability CIC 10169i Must prominently display information concerning the right of the insured to request an independent medical review 13
2020 Disability CIC 790.03h5 Not attempting to effectuate prompt, fair, & equitable settlement when liability clear. 39
2020 Disability CCR 2695.5b Must provide complete response to claimant inquiries within 15 calendar days. 11
2020 Disability CCR 2695.3b2 Must record date documents received. 2
2020 Disability CCR 2695.5a Must respond to the California Department of Insurance within 21 calendar days. 7
2020 Disability CCR 2240.1b6 Network providers available in network facilities 2
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. 3

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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