Missouri DOI Returns $6.5M to Consumers in 2010

Consumers who filed complaints with the Missouri Department of Insurance have received $6.5 million from their insurance companies in 2010. The money was returned as a result of the department’s mediation efforts on behalf of consumers who had filed complaints against their insurance companies, often because of the way their claims were handled.

The most common reasons for complaints to the department included denial of claims, claim delays, and unsatisfactory offers. The department recorded the most complaints for these types of insurance: health, auto and homeowners. Some notable accomplishments from the past three months:

The department helped recover more than $55,000 for a consumer who had emergency surgery after a heart attack while away from home. The insurer denied the claim, saying he was out of network. The company also denied the consumer’s appeal. After a complaint was filed with the department, the insurer overturned the decision, saying it was a true emergency and all claims were paid as if they were in network.

A small business owner who lost power during an ice storm was denied business interruption coverage by his property insurance company. After the department got involved, the company re-opened the claim and determined there was in fact coverage under the policy. The business owner got $130,402 for his claim.

After a car accident, a consumer found out her auto insurance had been canceled the day before. The insurance company said the consumer hadn’t paid her bills. The department contacted the insurance company, which determined the consumer had paid her premiums, but the money had been misapplied. The company agreed to pay the claim and cover damages and a rental car – for $9,000.

“We want consumers to know they have free assistance available from our department when it comes to disputes with their insurance companies,” said Missouri Insurance Director John M. Huff. “Insurers must live up to the obligations in their policies, and our team is here to make sure that happens.”

In the first three quarters of 2010, the department fielded more than 3,200 formal complaints and assisted 2,600 consumers in writing and another 15,500 over the telephone.

The top categories of complaints were as follows:

The Missouri Department of Insurance, Financial Institutions and Professional Registration (DIFP)