How to Handle Insurance Complaint?

[markinsurance5]

post deleted.....

 

[Heather]

What type of insurance are we talking about here? Complaints to the dept of insurance or to a carrier?

 

[djs]

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

 

[Norwayguy]

Oh ok- I didnt realize this. Well in my situation, I had a female client of mine file a frivolous complaining claiming that I didnt show her compassion and lied to her about a policy and then 'blocked her." the reality is that, I assisted her with a policy- health, and explained to her the options in case the plan wouldn't cover her grandson's transplant. All I got from her was one Saturday morning she wrote me a demanding email to call her- I did and her only response to my explanation was "ok."

Weeks later, I get a long harassing email from her claiming I lied to her, she's unable to change her plan, and that she holds me responsible for everything that happens to her grandson and she will never forgive me. She was irrational, emotional and in my opinion just outright crazy. She was also angry I didnt return her call the day before, called the marketplace, got some wrong information and then emailed me angry and took it out on me.

Her statements were "YOU LIED"!!!!! I WILL NEVER FORGIVE YOU FOR THIS NEITHER WILL MY GRANDSON AND I WILL HOLD YOU PERSONALLY RESPONSIBLE FOR EVERYTHING THAT EVER HAPPENS TO HIM!"

along with statements regarding God. She was pretty outrageous. As a result, I expressed to her that I refuse to be her agent any longer because she is being abusive towards me and ceased communication with her.

Next thing I know, she filed a very bogus complaint slandering me, completely misconstruing the entire situation, claiming I didn't care and lied to her- it was ridiculous. I'm not sure what grounds or rights I have here or how the DOI perceives any of this. It's a little scary.. I also feel she has been malicious towards me and this complaint was not out of her being a victim in any ways- she is just taking her anger out on me and filing bogus complaints- she's crazy I think. It's frustrating to know that a 'consumer' has this kind of power. A year ago I got mistreated by an agency manager quite badly, and attempted to contact a consumer divison to file a complaint against him- no one even bothered to take my complaint and they said they couldn't. Yet, some imo mentally ill female who is angry and abusive can file a false complaint against an honest agent.

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.

 

[GoPokes]

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.

 

[djs]

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

 

[LGilmore]

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?

 

[djs]

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

 

[FireDragon]

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.