How to Handle Insurance Complaint?

Sep 1, 2015

  1. markinsurance5
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    markinsurance5 Expert

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    post deleted.....
     
    Last edited: Mar 31, 2016
  2. Heather
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    Heather Guru

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    What type of insurance are we talking about here? Complaints to the dept of insurance or to a carrier?
     
    Heather, Sep 1, 2015
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  3. djs
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    djs Super Moderator Moderator

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    Always serious. Respond to them.
    If its a frivolous claim, then the outcome will be quick and easy. Don't treat it as anything but a serious claim though.

    The only complaint I had filed against me was from someone who thought he could use it as a mechanism to get a lower auto premium. Well, that didn't work out well for him, but it still consumed probably 10-15 hours of my time to document why his premium is what it is, which, as you know, I had no control over in the first place.

    But, if I didn't respond in a complete and timely manner, I would have had my appointment pulled and the DOI would perhaps have pulled my license. Other than a few wasted hours, nothing happened.

    Respond. Be factual and non-emotional.

    Dan
     
    djs, Sep 1, 2015
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  4. Norwayguy
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    Norwayguy I have spent way too much time here.

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    Hopefully you have good documentation. Preserve any emails voice mails etc...... Once they go crazy I want to respond in writing only for t b email paper trail. Have someone else review responses before sending to make sure they make sense to a consumer.
     
  5. GoPokes
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    GoPokes Guru

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    The DOI will probably ask you for an explanation. I would just answer them clear and concisely. Tell them when you met and what was discussed, the sequence of events. There's no need to address the woman's crazy statements and behavior (she is obviously very stressed and emotional, and the DOI will see that as well).

    The DOI takes these seriously bc they are in place to protect consumers, however I don't think you will have appear in court like Tom Brady did with the NFL.

    Dont let this keep you from working, that's where it would really cost you money, in lost opportunity.
     
    GoPokes, Sep 2, 2015
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  6. djs
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    djs Super Moderator Moderator

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    Yeah, don't describe it the way you did here. You want to come across as the calm one.

    Stick to facts, leave out opinions. Don't call her crazy, don't use the word victim.

    Also, understand she has her own view of the facts. Something happened that caused a problem that triggered all of this. That was a huge stress factor for her and somewhere, she feels you are responsible in someway. This doesn't make her right, but be empathetic in her problem as well. I doubt this is because her son has a skinned knee and a $5 bandaid wasn't covered.

    Dan
     
    djs, Sep 2, 2015
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  7. LGilmore
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    LGilmore Guru

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    So apparently the carrier blocked the transplant? BIG RED FLAG there! When people are asking about specific high cost services it should alert you to something being up.

    The big thing would be if you provided materials to her about the plan to review before you signed her up? Seems like she asked you something specific, how did you approach that after the question?
     
  8. djs
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    djs Super Moderator Moderator

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    I missed the transplant reference.

    Did the plan she had previously provide better coverage for the transplant?

    With this going on, what was the reason for switching her plan?

    Dan
     
    djs, Sep 2, 2015
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  9. FireDragon
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    Ok so you should have on record what her previous plan coverages were, if you didn't take the time to do that it's not going to look very good.

    Also, stop calling her mentally unstable or a sicko or anything like that because the DOI isn't going to care what your diagnosis is, they just want the facts to see if you did something worthy of a complaint.

    IMO you could be in a sticky situation because you didn't know about her previous insurance and you didn't check on the transplant coverage before writing the policy. Just telling the insured to do that isn't good enough, not in today's world.
     
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