Pennsylvania Insurance Department Complaint Handling

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Presentation transcript:

Pennsylvania Insurance Department Complaint Handling Carolyn M. Morris Director Bureau of Consumer Services

Pennsylvania Insurance Department Complaint Handling Office of Market Regulation Bureau of Market Actions Bureau of Consumer Services Bureau of Enforcement

Pennsylvania Insurance Department Complaint Handling Bureau of Consumer Services Health Insurance Division Life Insurance P&C Intake Unit

Pennsylvania Insurance Department Complaint Handling Insurance Marketplace What is a complaint? Complaint ..An expression of grievance or dissatisfaction associated with a licensee of the Department

Pennsylvania Insurance Department Complaint Handling Confirmed Complaint A complaint is one in which the insurer, producer or other regulated entity is determined to have committed any violation of an applicable state insurance law or regulation, a federal requirement that the we have the authority to enforce, or a term or condition of the insurance policy or certificate. A confirmed complaint also includes where the complaint and the entity’s response, considered together, indicates that the entity was in error. (i.e. market conduct note, market conduct referral, enforcement referral)

Pennsylvania Insurance Department Complaint Handling How Are Complaints Received and Tracked? Consumer Portal Fax Mail In Person NAIC Standard Coding System

Pennsylvania Insurance Department Complaint Handling What is the complaint handling process? Complaint

Pennsylvania Insurance Department Complaint Handling How is Complaint Information Shared? Public Information Requests (Aggregate) NAIC Complaint Data System Complaint Comparison Tool Insurer Complaint Reconciliation Tool Market Analysis Market Regulation Meetings

Pennsylvania Insurance Department Complaint Handling What’s In the Future? Insurer Portal

Pennsylvania Insurance Department Complaint Handling 2015 Total – 12,329

Pennsylvania Insurance Department Complaint Handling 2015 Complaints By Problem Type LINE OF BUSINESS CLAIMS HANDLING MARKETING AND SALES POLICYHOLDER SERVICES UNDERWRITING Grand Total HEALTH 2092 111 984 546 3733 AUTO 1610 74 535 2382 4601 FIRE 106 17 25 236 384 HOME 583 38 112 1365 2098 LIAB 81 4 11 50 146 LIFE 195 163 597 153 1108 MISC 129 46 54 60 289 4796 453 2318 4792 12359

Pennsylvania Insurance Department Complaint Handling Questions?