The Missouri Department of Insurance helped consumers who filed a complaint against their insurance company receive an additional $6.3 million in claim payments in the first half of 2015.
Health insurance generated the most complaints in the first half of 2015 with 910 formal complaints, followed by auto insurance with 413. Consumers filed the most complaints for denial of claims and delays in processing.
Some notable recoveries for consumers:
- A Jackson County consumer’s hospitalization claims were initially denied by his insurer. The insurer said the hospitalization was due to complications from bariatric surgery, which was excluded under the policy. The consumer contacted the department and filed an appeal. The claim denial was overturned and the consumer received $203,289.
- A Franklin County resident sustained extensive damage to his home from an April storm. Hail damaged the structure and water and mud damaged the basement. The consumer contacted the department for assistance after the water and mud damage was excluded from coverage. With the department’s help, the consumer recouped $34,960 for the hail damage.
- A lender filed a complaint with the department after an insurance company issued a check for a fire claim that destroyed a mortgaged property. The insurance company stopped payment on the check shortly after it was issued to continue their investigation against their insured. Once the department became involved, the company reissued the check totaling $107,470, ultimately satisfying the loan balance.
- A St. Louis County property owner filed a claim with his insurer after a 2012 wind storm damaged several properties. His contractors said work had to be performed that was not included in the original insurance estimate. The property owner sent multiple requests to the insurer to re-inspect the damaged properties. The insurer claimed the damage most likely was caused by a later storm. After the property owner filed a complaint with the department, the insurer met with the contractor. A payment of $512,596 was made to complete repairs from the 2012 storm.
In the first half of 2015 the department answered 12,313 phone calls, handled 3,720 inquiries and assisted with 2,249 complaints. The top categories of complaints were:
|Complaints by reason||Complaints by line of insurance|
|Denial of claim (519)||Health (910)|
|Delay of claim processing (437)||Auto (413)|
|Coverage question (189)||Life and annuities (253)|
|Unsatisfactory settlement/offer (158)||Homeowners (184)|
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