Missouri Insurance Regulators Help Recover $7.4M for Consumers

The Missouri Department of Insurance announced it helped consumers who filed a complaint against their insurance company receive an additional $7.4 million in claim payments in the first half of 2014. Health insurance topped the list of complaints.

The department received numerous complaints from consumers about health provider networks. Consumers complained most about access to care, out-of-network benefits, inadequate provider networks and provider availability. With open enrollment approaching for many Missourians, the department is strongly encouraging consumers to review their provider network options before enrolling in a health insurance plan for 2015.

Health insurance generated the most complaints in the first half of 2014 with 901 formal complaints, followed by auto with 375 formal complaints. Consumers filed the most complaints for denial of claims and delays in processing.

Some notable recoveries for consumers:

• A Jackson County man sustained extensive damage to his home after his pipes burst. His insurance company initially denied the claim, arguing he had not taken necessary precautions to avoid the incident. After receiving a complaint from the department, the company reversed its position based on evidence that the homeowner had taken all reasonable actions to prevent the loss. The company paid $16,920 for the loss.
• A Lincoln County man was involved in a motorcycle accident in which it was determined he was not at fault. He was having problems getting a fair settlement and reimbursement for storage fees. After filing a complaint with the department, the insurance company re-evaluated the claim and paid $17,976 for damage and storage fees.
• An insurance agent encouraged a recently widowed woman to transfer her annuities, which cost her large surrender penalties. The woman’s husband previously handled all of their finances, which left her vulnerable. Shortly after the free-look period ended, the woman discussed the transfer with a friend, who was an insurance agent. The agent contacted the department and a complaint was filed. The receiving company returned all the funds and the original company reversed the surrender charges. The process returned the woman back to her original status without penalties of $195,569.
• A consumer canceled a Medigap policy and received a new one while receiving care in a nursing home. The two companies involved refused to cover claims for the stay in the nursing home. After the department got involved, the two companies agreed to split the cost of the medical claims totaling $10,000.

In the first half of 2014 the department answered 14,334 phone calls, handled 5,011 inquiries and assisted with 2,266 complaints. The top categories of complaints were:

Source: Missouri Department of Insurance

Topics Missouri