Consumers, including residents in Joplin and Springfield, who filed complaints with the Missouri Department of Insurance in the first quarter have received an additional $2.2 million in claim payments from their insurance companies, according to a news release from the department.
The department received more than 10,000 complaints or inquires in the quarter, up from 7,500 at the same time a year ago. During the first quarter, the department handled more than 1,030 formal complaints, helped nearly 2,640 consumers in writing, and assisted 6,600 via telephone, the release said.
Among notable first-quarter assistance:
- A Joplin woman was having home repairs completed after the tornado that ravaged the city last May, and her contractor found additional damage. The woman was having a hard time getting her insurance company to pay for additional repairs and living expenses. After she contacted the department, the insurance company issued an additional payment of $122,500 for the woman’s home, property and living expenses.
- A Springfield woman was having a difficult time with her insurance companies after seeking cancer treatment at a Texas hospital. Since she had recently changed health plans and the hospital was out of state, her former insurance company paid for the services, but soon realized its error and billed the woman for $8,000, the release said. The department argued that the hospital was obligated to submit a claim to the correct insurance company and refund any overpayment, but the hospital refused. The department then submitted letters to the insurance companies, the Texas insurance commissioner and a state legislator, requesting that the companies work together to correct the problem. Once the letters were received, the claim was resubmitted to the correct company and payment was made.
"Missouri consumers who have claims denied by their insurance companies or feel their claim settlement is unfair should not assume they've run out of options," said John M. Huff, director of the Department of Insurance, in the release. "Our expert regulators are here to provide help at no charge to Missouri policyholders who reach an impasse with their insurance companies."
According to the department, the most complaints were generated regarding health insurance, followed by auto and homeowners’ coverage. By type of complaint, the most common reasons for complaints were denial of claim, delay of claim processing and unsatisfactory offers.
The department's Market Conduct Section also has returned $663,000 to consumers as a result of exams and investigations – which consider treatment of policy holders, rates and how claims are handled – in the first quarter. Results of those exams can lead to refunds, fines, changes in business practices or other remedies. Enforcement actions also resulted in nearly $243,000 in fines for insurance companies.
Questions or complaints can be made at the department’s Insurance Consumer Hotline at (800) 726-7390 or online at Insurance.MO.gov