North Carolina Cites $26M in Consumer Recoveries in 2012

January 31, 2013

North Carolina’s Insurance Commissioner Wayne Goodwin announced that the state’s insurance department saved or recovered more than $26 million for North Carolinians in 2012.

“The Department of Insurance is committed to fighting fraud, assisting North Carolinians with insurance questions or complaints, and holding members of the insurance industry to the highest professional standards,” said Commissioner Goodwin. “I am very proud of our track record of recovering and saving money for our citizens.”

Several divisions of the insurance department contributed to the total recoveries and savings:

• The Consumer Services Division, which receives consumer inquiries and complaints about homeowners, auto, life and other insurance-related issues, handled approximately 65,000 calls and 7,500 written complaints from the public. Through these calls and complaints, the department was able to help citizens recover more than $10.4 million in benefits from insurance companies.

• Health Insurance Smart NC returned $1,979,398 to consumers as a result of services provided. Health Insurance Smart NC, the department’s newest consumer assistance program, assists people with questions about health insurance, and helps consumers file complaints or appeals with their health insurance companies, identify enrollment opportunities and request external reviews for denied claims.

In 2012, Smart NC specialists took in over 14,000 calls, responded to 1,248 consumer complaints, 361 health insurance enrollment inquiries and 352 medical appeal cases, and handled 282 external review requests.

• SHIIP, the Seniors’ Health Insurance Information Program, assisted more than 100,451 consumers with general Medicare questions and helped more than 10,200 Medicare recipients apply for the Low-Income Subsidy program that provides savings for prescription drug costs.

The estimated cost savings for Medicare beneficiaries was $10,883,676. SHIIP offers free, unbiased information about Medicare, Medicare prescription drug coverage, Medicare Advantage, long-term care insurance and other health insurance information. SHIIP’s trained volunteers provide one-on-one counseling in all 100 counties.

• The Criminal Investigations Division employs 20 sworn law enforcement officers dedicated to investigating claims of insurance fraud and criminal concerns associated with bail bonding, motor clubs, collection agencies and premium finance companies.

In 2012, the work of these criminal investigators led to 156 arrests, 75 criminal convictions and more than $2.7 million in restitution and recoveries. Another 117 cases are currently pending in court.

• The Agent Services Division regulates all licensed agents, brokers, limited representatives, appraisers, adjusters, premium finance companies, collection agencies, motor clubs, bail bondsmen, surety bondsmen and bail bond runners authorized to do business in North Carolina.

Oversight includes licensure qualification, pre-licensing education, continuing education, telephone inquiries, complaint investigations and agency examinations. The division investigated more than 943 complaints and recovered $44,834 in premium funds for consumers.

• The Market Regulation Division conducts both routine and targeted market conduct examinations on foreign and domestic licensed companies (insurance companies, premium finance companies, HMOs, PPOs and more) to ensure compliance with state laws and regulations. Through these exams, the division ordered $411,068.53 returned to policyholders.

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