Questions on a Dept of Insurance Complaint

[navigator]

I have a general question that maybe some others can help me out with. To make a long story short, I received a department of insurance complaint in February 2012 because a client that I had moved some money from Bankers Life to a new company, this client did incure some surrender charges however was well aware of them and even signed his statement where the surrender charges showed, almost 4 months later after delivering the policy the client becomes irate and states he new nothing about the charges and also during this time one of the policy documents was altered to show a deposit of the amount without the surrender charge and wanted his entire amount back including the surrender charge which obviously the new company did not have. I responded to the complaint in March of 2012 and sent my documentation to the home office that I was captive with at the time and never heard anything back until January of 2013 when I received an email from the DOI wanting to ask some additional questions which I had met with them and answered what I could. As of today I still have not heard anything back and curious if anyone has went through a department of insurance complaint and how they work...

 

[donamese]

I have a general question that maybe some others can help me out with. To make a long story short, I received a department of insurance complaint in February 2012 because a client that I had moved some money from Bankers Life to a new company, this client did incure some surrender charges however was well aware of them and even signed his statement where the surrender charges showed, almost 4 months later after delivering the policy the client becomes irate and states he new nothing about the charges and also during this time one of the policy documents was altered to show a deposit of the amount without the surrender charge and wanted his entire amount back including the surrender charge which obviously the new company did not have. I responded to the complaint in March of 2012 and sent my documentation to the home office that I was captive with at the time and never heard anything back until January of 2013 when I received an email from the DOI wanting to ask some additional questions which I had met with them and answered what I could. As of today I still have not heard anything back and curious if anyone has went through a department of insurance complaint and how they work...

A. They work slowly. Depending on the state, some are amazingly slow. Keep in mind, they also wait on the insurance company and the individual to reply then that reply is at the bottom of the pile.

B. Just because they ask questions of you, it doesn't mean you are suspect. They are just getting the whole story together so they can reply accurately to the client. Clients send in complaints all the time and many aren't justified. So long as you didn't do anything wrong, you shouldn't have to worry about it.

 

[VolAgent]

WAG, he is probably busy explaining why he committed fraud to the DOI.

He altered insurance documents with the intention to deceive an insurance company. That is insurance fraud all day long. I personally wouldn't give this another thought. As soon as the DOI saw the documents didn't match what the HO had and what you had, the investigation against you or the company stopped dead in its tracks.

 

[navigator]

Thanks for the replies, I was worried because I had tried contacting the lady who was working on the complaint and could not get any response back from her, so I guess no news is good news? LoL, I am just having a hard time having my name being associated with this when I know I did nothing unethical.

Thanks again!!!

 

[JRoot]

I had a complaint to a state DOI once. Long story short - I sold a non-med product over the phone to someone who lied on the application and didn't disclose they had terminal cancer. It somehow got through underwriting and the person passed away 9 months later. The life insurance company obviously didn't pay the claim and the beneficiaries went after me via the DOI. I ended up sending my proof in and never heard anything back - I've been writing business in that state since (3 years ago), so I guess my proof was good enough.

In my situation, no news was good news.

 

[navigator]

I just dont like the idea that this client stated on the DOI complaint that I handed him the document that was altered...

 

[Mattschmidt]

I just dont like the idea that this client stated on the DOI complaint that I handed him the document that was altered...

Unfortunately, clients lie sometimes....Just tell the truth, document everything, and you will be fine. I don't think you have anything to worry about

 

[ILSAinc]

If you have never received an Administrative Action (or Sanction) notification, for this incident, chances are that the investigation slowed and will be closed as unsubstantiated. To make sure, you should sign on to the Department of Insurance website for the state in question and look up your license information, including administrative actions.

If you have received an action for this and somehow overlooked the official notification, be aware that, if you have licenses in other states, you have 30 days (in most states) to report this action to all the other states where you hols a license. If you are the designated producer/agent or an officer of an agency, you will need to report the administrative action for the agency as well. You cannot wait to report the action at renewals time.

Failure to properly report administrative actions in a timely manner can lead to a domino effect of sanctions which becomes costly over time.

That all being said, if you have never been notified and can't locate any actions listed at the state, you may be in the clear or will, at some point in the unknown future, receive the final outcome report on this investigation.

Good luck to you and remember, documentation is key in the area of CYA.

Lisa Miklojachak
[email protected]

 

[navigator]

Thanks Lisa, I have never received anything further on this since I spoke with them again back in January of this year.