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
2021 317 152 128 37 87
2020 368 145 177 46 118
2019 594 192 333 69 136

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
2021 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 44
2021 Disability CIC 785 Senior Issue - duty of honesty, good faith, & fair dealing 1
2021 Disability CIC 10120.2(c) Dental policies must include their coordination of benefits provision prominently in the evidence of coverage or insurance policy 1
2021 Disability CIC 10123.147b Emergency services claim is unpaid, uncontested or not denied within timeframe must contain penalty when paid 2
2021 Disability CIC 10123.147a Emergency services claim must be paid, contested or denied within 30 working days by written notice with required language 2
2021 Disability CIC 1861.05a Excessive, inadequate, unfairly discriminatory rates 1
2021 Disability CCR 2694a6 Facts of the complaint merit remedial action 18
2021 Disability CCR 2694a5 Failed to respond or did not provide a complete response 4
2021 Disability CIC 790.03h3 Failing to adopt & implement standards for the prompt investigation & processing of claims 24
2021 Disability CIC 790.03h13 Failing to provide an explanation of denial using policy provisions. 1
2021 Disability CIC 880 Failure of insurer to use own name 5
2021 Disability CCR 2695.3a File must contain all documents. 4
2021 Disability CIC 10123.13b For uncontested claims not paid within 30 days interest is due at 10% per year. 3
2021 Disability CCR 2694a3 In contravention of own rules, policies, procedures, guidelines 6
2021 Disability CIC 10133.66b Insurer cannot request overpayment of claim unless written request for reimbursement is sent with 1 yr; not for fraud 1
2021 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
2021 Disability CIC 790.03h1 Misrepresenting facts or policy provisions. 5
2021 Disability CCR 2695.7b1 Must deny all claims in writing. Must cite statute, applicable law or policy provision on 1st party claims. 1
2021 Disability CIC 10169i Must prominently display information concerning the right of the insured to request an independent medical review 6
2021 Disability CCR 2695.5b Must provide complete response to claimant inquiries within 15 calendar days. 2
2021 Disability CCR 2695.5a Must respond to the California Department of Insurance within 21 calendar days. 12
2021 Disability CCR 2240.1b6 Network providers available in network facilities 4
2021 Disability CIC 790.03h5 Not attempting to effectuate prompt, fair, & equitable settlement when liability clear. 9
2021 Disability CIC 788.5b Sale of disability policy to person aged 65 or older on Medicare is overloading 1
2021 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

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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