INSURANCE REFUNDS IN CALIFORNIA by Brad Richdale

Disagreements sometimes arise regarding an amount due on an insurance bill, the amount a company has paid on a claim, or even the nonpayment on an insurance claim. posted by Brad Richdale When you’ve been taken advantage of monetarily by an insurance broker, it’s often very difficult to navigate through a library of resources on the Internet and through insurance commissioners to find the appropriate information on how to file a dispute. In this chapter, we will discuss what to do before you file an insurance complaint along with a step-by-step process on how to file a dispute with your state’s insurance commissioner.

To begin, an insurance commissioner is an elected executive office or cabinet position who is also in charge of the Department of Insurance in the state in which you reside. Each office differs state by state. The individual’s duties are to: Oversee and direct all functions of the Department of Insurance; licenses, regulates and examines insurance companies; answers public questions and complaints regarding the insurance industry; and enforces the laws of their state’s Insurance Code and adopts regulations to implement the laws.

In some states, the insurance department or division is autonomous; in other states, the department is part of a larger body of government. The National Association of Insurance Commissioners (NAIC) is the professional association for these officeholders.

Before you file an insurance complaint, there are a few factors you should go over and fulfill before bringing the case to an official commissioner. Varying by each state, the commissioner handles most insurance problems involving home, business, auto, health, HMO, life, dental, among others. These problems may include claim disputes, sales misrepresentations, coverage issues, premium problems, policy cancellations and refunds. Some insurance commissioners will also investigate complaints against insurance producer/brokers and public adjusters. Depending on which state you reside in, it could take upward of 45 days for investigation and resolution of a complaint.

Contact your insurance company first if you have a claim dispute. When contacting your insurance company, have your policy number on hand. Ask the insurance representative where your written dispute needs to be sent. State your complaint and how you anticipate the company to resolve it. Keep in mind that sending the dispute in writing encourages a written response.

Remember to always document your phone calls by noting the phone number you called, name of the person with whom you spoke, date of the call and a concise summary of the conversation. Keep copies of all written communications for future use. Along with the written complaint, send copies of letters, invoices, notes, advertising collateral, canceled checks, or other certificates that support your complaint and keep the original copies safely stowed away.

There are also a number of items that your state’s insurance commissioner cannot aid you with during the filing process:

• Take on the role as your legal representative, in or out of court.
• Get involved in a pending lawsuit or case where you are represented by legal counsel, or execute a judgment.
• Give a medical decision of an individual’s medical condition. However, some commissioners can investigate to conclude if the denial is arbitrary or impulsive and whether or not the denial decision was made in accordance with the terms of the insurance contract and state insurance laws and regulations.
• Determine disputes between policyholders or claimants and insurance companies, or their  representatives, that involve the following matters:
• Who is negligent or at fault;
• The facts surrounding a claim, meaning who might be telling the truth in the matter when accounts of the case differ;
• The value of a claim or the total of money owed to you; or
• Any other factual disagreements between you and any other party.
• Classify an insurance company with whom a person may have a policy;
• Settle complaints against service providers unless the objections involve the actions of insurers.

In order to resolve your dispute efficiently and agreeably, consider these following steps on how to file a dispute with your state’s insurance commissioner.

Gather all the information and documents available regarding the insurance policy. If you know where the actual policy is physically, then make sure it is available to you. Check all your files for any communication between the insured and the insurance company. Any suggestion that the policy exits and that the insurance company had a contractual obligation will be significant to your case. It is important to also look to see how the policy was being paid.

Speak with the adjuster associated with your claim. Ask for an explanation of the details reason why your insurance claim was denied, unpaid or taken advantage of. They will tell you if it a policy interpretation question or any other concern that may have risen. They will be prepared to offer you more information than simply denying your claim.
For more information go to http://insurance.ca.gov/

                                      written by Brad Richdale 2011 all rights reserved