DCI News

Jefferson City, Mo. - The Missouri Department of Insurance announced today that consumers who filed complaints against their insurance companies received an additional $12.8 million in claim payments in the first three quarters of 2013. The recoveries already surpass last year's annual amount of $11 million.

 "Consumers need to know they have a free resource in our department that can help them navigate the sometimes complex world of insurance claims," said Missouri Insurance Director John M. Huff. "Often times a call or a letter from our technical experts is all it takes to resolve a dispute between policyholders and their insurance companies."

Some notable accomplishments:

• A former employee of a small business contacted the department after a health insurance claim on her group policy was denied. The former employee thought she had health coverage when she had surgery. The insurance company approved the surgery and initially paid her claims but, soon after, requested the payments back. Her former employer had canceled her coverage retroactively to the surgery. The former employee, who was not notified, also began receiving medical bills. That was when she filed a complaint. The department's consumer affairs team contacted the insurance company and requested her coverage be temporarily reinstated as COBRA, with premiums to be paid by the former employee. Under federal and state law, employers that have a group health plan are required to offer their employees (and their dependents) the option of continuing their membership in the group plan at their own expense after they leave their job. This is known as "electing COBRA," and these employees are entitled to continue coverage for 18 months. The company reinstated the coverage and paid $45,722 for her medical bills.
• A Pettis County business owner's building collapsed from a February snow and ice storm. Still waiting for his insurance claim to be paid in August, the owner filed a complaint with the department. The insurance company paid $466,839 to cover damage to the building and contents, and for loss of business income.
• Neighbors noticed water running out of a home whose owner was in a nursing home. The insurance company refused to cover the damage, citing long-term deterioration of the pipe. After a complaint was filed with the department, the insurance company reviewed the claim again and determined coverage would apply as a sudden bursting of a pipe. It paid $57,428 for damage.

In the third quarter of 2013, the department handled more than 1,083 formal complaints against insurance companies, assisted nearly 2,278 in writing and helped more than 5,444 consumers who called.

Health insurance generated the most complaints in the third quarter with 324 complaints. The top complaints by reason and type of insurance were:

Consumers with complaints or questions about their insurance agent or company can call the department's Insurance Consumer Hotline at 800-726-7390 or visit insurance.mo.gov.