The Consumer Affairs and Market Regulation divisions of the Missouri Department of Commerce and Insurance (DCI) helped consumers receive an additional $23.9 million from their insurance companies in 2020, the department reported.
The monies were returned as a result of the Consumer Affairs Division’s mediation work on complaints filed by consumers, as well as the efforts of the Market Regulation Division in ensuring compliance with Missouri insurance laws.
In 2020, the Consumer Affairs Division received 2,952 formal complaints and returned $8 million to consumers.
The largest driver of complaints continues to be health insurance with claim denials and delays as the top reasons for complaints.
In one notable accomplishment for 2020, a complaint was filed regarding payment for autism services. An internal error was discovered at the company level resulting in the denied claims. The Consumer Affairs Division monitored the reprocessing of the affected claims which resulted in a recovery of nearly $89,000.
The Department’s Market Regulation Division focuses on identifying and resolving systemic issues that impact Missouri insurance consumers.
In some instances, market regulation actions may originate from consumer complaints that have been filed with the Department’s Consumer Affairs Division.
In other instances, the issues are identified through a review of insurance company filings and by monitoring insurance company activities in the insurance marketplace.
In 2020, the Market Regulation Division recovered $15.9 million. That money went to 82,219 Missouri insurance consumers.
Consumers benefit from restitution by receiving refunds from insurance companies for premium overcharges and by receiving payment from insurance companies for claims that were improperly denied or were underpaid.
Source: Missouri DCI
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