By Sara BlackwellAttorney
We live in a world governed by insurance companies. From house and life insurance to car and health insurance, it is virtually impossible to live or work in the United States without owning some type of insurance policy. Those who do not have health or car insurance due to a lack of financial ability are generally the ones who most need the protection.
The purpose of insurance is protection but it does not always turn out that way in all situations. There are times when a policy holder disagrees with the insurance company or feels mistreated in one way or another. Individual policy holders do have some rights and options when it appears that the insurance company acted incorrectly or negligently.
Of course, a policy holder can contact an attorney to file a civil complaint in court, but that is too extreme for most disputes with insurance companies. Another, easier option, is filing a complaint with the Louisiana Department of Insurance. The Department of Insurance has the power to enforce Louisiana Insurance Laws or simply provide individuals with consumer insurance information. The Insurance Department can also investigate into policyholder complaints against insurance companies, agents, and adjusters.
A complaint can be brought against the following types of insurance: life, health, disability, health, auto, worker’s compensation, annuity, Medicare Supplement, credit, fire/homeowner, business or other non-specified types of insurance.
Contrariwise, the Louisiana Insurance Department lacks the authority to offer legal advice, act as an attorney on a policy holder’s behalf, or interfere in pending litigation. The Department cannot decide disputes as to who is negligent or at fault, resolve a dispute between one person’s word against another or make factual determinations. With these limitations in mind, a complaint can be filed online or mailed to the Louisiana Department of Insurance.
The complaint requires personal information such as name, address, and contact information. A claimant also has to provide detailed information about the insurance company or agent, including, but not limited to, the type of insurance coverage, policy number, date of alleged loss, and name of insurance company. The final section of the complaint form requires details of the bases for the grievance. A comprehensive description of the disputed issue must be provided together with an explanation as to what the policy holder considers a fair resolution of the problem.
Along with the complaint form, several documents must be provided to the Department of Insurance. These documents include: letters written to the insurance company in reference to the alleged problem, letters received by the policy holder from the insurance company, any other letters or documentation in reference to the relative issue, and all policy information or handbook verbiage referencing the subject. Copies, not originals, of such documents should be sent along with a copy of the claimant’s insurance card, if one is available.
After a complaint is properly filed, the Department of Insurance will send an acknowledgement letter setting forth the file number and name of the examiner in charge of investigating the complaint. The Department will then send a copy of the complaint to the particular insurance company or appropriate agent/agency and request an explanation of their decision. The assigned examiner will consider and review the complaint along with the insurance company or agent’s response. The examiner may find it necessary to request further information or documents from the claimant or the insurance company/agent.
After a result is determined, the examiner will mail the claimant a letter of explanation. If the Department of Insurance believes the law was violated, the Department will pursue administrative action against the insurance company to correct and punish the company. If the examiner finds no evidence of a violation of the insurance law, the investigation will be closed and no action will be taken against the insurance company/agent. Finally, if the insurance company does not provide sufficient information for the examiner to make a proper decision, the investigation will continue until further information can be secured. The investigation typically averages 60 days for completion; however, this varies depending on the intricacy of the surrounding issues.
It is beneficial to know that there are things individual policy holders can do to protect himself/herself from the seemingly untouchable, big insurance companies. Begin protecting yourself before signing with an insurance company by visiting the Louisiana Department of Insurance Website. The Insurance Department does not have the authority to recommend a particular insurance company, agent or adjuster. Yet, anyone has the ability to check any insurance company’s complaint rate on the Department website. It is wise to evaluate a prospective insurance company against other Louisiana insurance companies prior to purchasing a policy with that particular company.
The provided information is fact-sensitive and jurisdiction-dependent. Consult an attorney before employing the above legal concepts.
Sara Blackwell is an attorney, writer, and mother. She has worked as an attorney for the United State’s Department of Justice, a federal district judge, and the United States Attorney’s Office. Her Current legal interest is in immigration law, where she works part-time for an immigration firm. She is currently working on her second novel.
