COLUMBUS — The Ohio Department of Insurance saved or recovered more than $10.3 million for Ohioans in 2010 announced Ohio Lieutenant Governor and Department of Insurance Director Mary Taylor during National Consumer Protection Week, March 6-12. Most of the savings came because of claim decision reversals and claim refunds.
Nearly one-third of the 5,152 consumer complaints received by the Department dealt with the denial of insurance claims. Of these, the majority related to denial of health insurance claims. The Department’s consumer services staff fielded 79,705 phone calls in 2010. There were 281 fewer consumer complaints filed in 2010, down from 5,433 complaints in 2009.
The following lists show the top five types of consumer complaints for Ohio and the United States:
Top five types of Ohio consumer complaints in 2010
1. Claim Denials, 30.9%
2. Claim Settlement/Payment Delays, 17.5%
3. Unsatisfactory Settlement/Offer, 13%
4. Policy Cancellations/Non-Renewals, 5.3%
5. Marketing/Sales Misrepresentations, 5.2%
Top five Ohio complaints by type of coverage in 2010
1. Accident/Health, 40.5%
2. Auto, 23.9%
3. Homeowners/Renter, 16%
4. Life and Annuity, 14.1%
5. Other Coverage, 5.5%
Top five types of national consumer complaints in 2010
1. Denial of Claims, 18.7%
2. Delays, 17.6%
3. Unsatisfactory Settlement/Offer, 14.9%
4. Premium/Ratings, 5%
5. Cancellations, 4.2%
Top five national complaints by type of coverage in 2010
1. Accident/Health, 36%
2. Auto, 35.8 %
3. Homeowners, 13.5 %
4. Life and Annuity, 9.8 %
5. Other Coverage, 4.9 %
This information is based on the submission of closed complaint data to the NAIC from the state insurance departments. Aggregate data can be accessed on the NAIC’s web site, www.naic.org.
To help avoid problems getting claims paid, the Ohio Department of Insurance offers these tips:
- Know Your Policy: Understand what your policy says. The 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: Don’t let the bills or receipts pile up. Call your agent or your company’s claims hotline as soon as possible.
- Provide Complete, Correct Information: Be certain to give your insurance company all the information they need. Incorrect or incomplete information will only cause a delay in processing your claim.
- Keep Copies of all Correspondence: Write down information about your telephone and in-person contacts, including the date, name and title of the person you spoke with and what was said. Also, keep a record of your time and expenses.
- 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.
- Don’t 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 against their insurance company or have insurance questions can call the Department’s consumer hotline at 1-800-686-1526 or visit www.insurance.ohio.gov.