COLUMBUS – Lieutenant Governor and Insurance Director Mary Taylor announced the Ohio Department of Insurance helped Ohio consumers save or recover $23.5 million in 2013 while assisting nearly 200,000 Ohioans mainly through its toll-free hotlines, community outreach efforts and counseling sessions. Taylor also announced the Department’s top types of consumer complaints based on both the reason for the complaint and by the type of coverage.
The Department’s savings and recovery figure includes $16.4 million by the Department’s Ohio Senior Health Insurance Information Program (OSHIIP), and $7.1 million from the Office of Consumer Affairs, which addresses non-Medicare insurance matters. Over the past two years, the Department has saved or recovered $48 million for Ohioans.
“Each and every day the Department is working with consumers to help resolve their complaints and answer their questions,” Taylor said. “As we continue to improve our processes and reach out to consumers more aggressively, we helped Ohioans save or recover $23.5 million in 2013.”
The Office of Consumer Affairs received 5,397 consumer complaints in 2013. The majority of the complaints dealt with insurance claim denial, claim delay or unsatisfactory claim settlement offers.
The following lists show the top types of consumer complaints for Ohio and nationally in 2013:
Top Types of Ohio Consumer Complaint Reasons:
- Denial of Claim/Adverse Benefit Determination – 22.9%
- Claim Settlement/Payment Delay – 12%
- Claim Settlement/Unsatisfactory Offer – 9.4%
- Underwriting/Cancellation or Non-Renewal – 4.2%
- Policy Service/Premium Notice Billing – 3.2%
Top Types of National Consumer Complaint Reasons:
- Claim Settlement/Payment Delay – 23.97%
- Denial of Claim/Adverse Benefit Determination – 15.63%
- Claim Settlement/Unsatisfactory Offer – 11.32%
- State Specific (Other) – 4.76%
- Underwriting/Cancellation or Non-Renewal – 4.51%
Top Types of Ohio Consumer Complaints by Coverage:
- Accident and Health – 41.4%
- Personal Auto – 24.3%
- Homeowners and Renters – 16%
- Life and Annuity – 12.8%
- Other Coverage – 5.5%
Top Types of National Consumer Complaint Reasons by Coverage:
- Personal Auto – 37.62%
- Accident and Health – 36.07%
- Homeowners and Renters – 12.57%
- Life and Annuity – 7.91%
- Other Coverage – 5.85%
The national 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.
Insurance Claim Tips:
- 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 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.
- 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. If your inquiry is Medicare related, call OSHIIP at 1-800-686-1578.
You can follow the Department on twitter @OHInsurance and on Facebook at www.facebook.com/Ohio
Department of Insurance.