COLUMBUS – Lieutenant Governor and Insurance Director Mary Taylor today announced the Ohio Department of Insurance saved or recovered $11.6 million for Ohioans in 2011. The Department also received 5,336 consumer complaints, the majority of which dealt with the denial of insurance claims.
Specifically, of the savings realized by Ohio consumers, $7.6 million came from complaints related to personal auto, homeowners and renters insurance. In addition, $2.6 million came from accident and health claims, $566,000 came from life and annuity claims, and all other coverage claims totaled $154,000.
“These savings reflect the hard work of our dedicated staff as well as my commitment to consumer protection,” Taylor said. “Since joining the Department, one of my top priorities has been – and will continue to be – providing Ohioans with high quality customer service.”
Also included in the total savings is more than $757,000 from last fall’s eight week Medicare annual open enrollment period. From October 15 to December 7, 2011, the Ohio Senior Health Insurance Information Program (OSHIIP) provided counseling and assistance to Ohioans over the phone and in person at more than 100 events across the state.
The following list shows the top types of consumer complaints for Ohio and the United States in 2011:
Top Types of Ohio Consumer Complaint Reasons:
- Denial of Claim – 32.3%
- Claim Settlement/Payment Delay – 15.5%
- Claim Settlement/Unsatisfactory Offer – 12.6%
- Premium Rating – 5.3%
- Policy Cancellation/Non-Renewal – 4.6%
Top Types of National Consumer Complaint Reasons (as of 12/26/11):
- Claim Handling/Delays – 24%
- Claims Handling/Denial of Claim – 14%
- Claim Handling/Unsatisfactory Settlement/Offer – 14%
- Claim Handling/State Specific – 7%
- Underwriting/Cancellation – 4%
Top Types of Ohio Complaints by Coverage:
- Accident and Health – 43%
- Personal Auto – 22%
- Life and Annuity – 11.8%
- Homeowners and Renter – 18%
- Other Coverage – 5.2%
Top Types of National Complaints by Coverage (as of 12/26/11):
- Accident and Health – 42%
- Auto – 33%
- Homeowners – 13%
- Life and Annuity – 7%
- Misc. – 2%
This information is based on the submission of closed complaint data to the National Association of Insurance Commissioners (NAIC). Aggregate data can be accessed at www.naic.org.
Tips to Help Get Insurance Claims Paid:
Know Your Policy: Your policy is a contract between you and your insurance company. Know what’s covered, what’s excluded and deductible amounts.
File Claims as Soon as Possible: Call your agent or your company’s claims hotline right away.
Provide Complete, Correct Information: Incorrect or incomplete information can cause a delay in processing your claim.
Ask Questions: If there is a disagreement about the claim settlement, ask the company for the specific language in the policy that is in the question. Find out if the disagreement is because you and the insurance company interpret your policy differently. If this disagreement results in a claim denial, make sure you obtain a written letter explaining the reason for the denial and the specific policy language under which the claim is being denied.
Do not Rush into a Settlement: If the first offer made by an insurance company does not meet your expectations, be prepared to negotiate to get a fair settlement. If you have any questions regarding the fairness of your settlement, seek professional advice.
Accident and Health Claims: Ask your physician to provide your insurance company with details about your treatment, medical conditions and prognosis. If you suspect a provider is overcharging, ask the insurance company to audit the bill and verify whether the provider used the proper billing procedure.
Ohio consumers who would like to file a complaint or have insurance questions can call the Department’s consumer hotline at 1-800-686-1526 or visit www.insurance.ohio.gov.