Reasons Why Closed Confirmed Consumer Complaints Were Reported
As of May 31, 2017
Data reflected in this report is voluntarily submitted to the NAIC proprietary Complaints Database System (CDS) by state
insurance departments. Not all states provide all of their complaint data to the NAIC. Aggregate report data retrieved is specific
only to risk bearing entities within the database and does not include information on specific agents/brokers. Complaints
retrieved are those states deem confirmed. The NAIC does not guarantee the truth, accuracy, quality or completeness of the
data and is not responsible for errors, omissions or for results of further use.
Report Description: The Reasons Why Closed Confirmed Consumer Complaints Were Reported report provides the counts
and percentages of the reasons consumers complain about their coverage (claim delays, claim denials, cancellation, premium
increases, etc.). The Top 10 Reasons section of the report provides a listing of the top 10 reasons with counts and
percentages of total counts. The All Reasons section provides the counts for all reasons from the NAIC's Complaint Database
System. The data codes identified are based on the NAIC Standard Complaint Data Form.
A Closed Complaint is a complaint that has been investigated by the state insurance department, and given a resolution
code.
A Confirmed complaint is a complaint in which the state department of insurance determines:
a) The insurer, licensee, producer, or other regulated entity committed any violation of:
1) an applicable state insurance law or regulation;
2) a federal requirement that the state department of insurance has the authority to enforce; or
3) the term/condition of an insurance policy or certificate; or
b) The complaint and entity’s response, considered together, indicate that the entity was in error.
Top 10 Reasons
2017
Reason for Complaint
Claim Handling - Delays
Claim Handling - Denial of Claim
Claim Handling - Unsatisfactory Settlement/Offer
Claim Handling - Prompt Pay
PolicyHolder Service - Coverage Question
Underwriting - Cancellation
PolicyHolder Service - Delays/No Response
PolicyHolder Service - Premium Notice/Billing
PolicyHolder Service - Premium Refund
Claim Handling - Adjuster Handling
% of All
Count Reasons
3,972
15.65%
3,600
14.19%
2,806
11.06%
1,404
5.53%
1,142
4.50%
1,139
4.49%
1,087
4.28%
1,015
4.00%
846
3.33%
783
3.09%
2016
Reason for Complaint
Claim Handling - Delays
Claim Handling - Denial of Claim
Claim Handling - Unsatisfactory Settlement/Offer
Underwriting - Surcharge
PolicyHolder Service - Coverage Question
Underwriting - Cancellation
PolicyHolder Service - Premium Notice/Billing
PolicyHolder Service - Delays/No Response
PolicyHolder Service - Premium Refund
Claim Handling - Prompt Pay
% of All
Count Reasons
14,323
15.42%
13,418
14.45%
8,706
9.37%
8,447
9.09%
4,301
4.63%
4,188
4.51%
3,921
4.22%
3,449
3.71%
3,215
3.46%
2,569
2.77%
Recipient agrees not to market, sell or distribute this data/report without the prior written consent of the NAIC. For reprint
permission please see www.naic.org/jsp/legal_reprints.jsp.
Report reflects data reported from the state insurance departments to the NAIC as of 5/31/2017.
Database: DSPLP
© 1990 - 2017 National Association of Insurance Commissioners. All rights reserved.
Page 1 of 6
Reasons Why Closed Confirmed Consumer Complaints Were Reported
As of May 31, 2017
2015
Reason for Complaint
Claim Handling - Delays
Claim Handling - Denial of Claim
Claim Handling - Unsatisfactory Settlement/Offer
Underwriting - Surcharge
Underwriting - Cancellation
PolicyHolder Service - Coverage Question
PolicyHolder Service - Premium Refund
Claim Handling - State Specific
PolicyHolder Service - Premium Notice/Billing
PolicyHolder Service - Delays/No Response
% of All
Count Reasons
14,356
16.86%
13,353
15.68%
8,486
9.96%
7,372
8.66%
4,096
4.81%
3,265
3.83%
3,223
3.78%
3,188
3.74%
2,918
3.43%
2,606
3.06%
2014
Reason for Complaint
Claim Handling - Delays
Claim Handling - Denial of Claim
Claim Handling - Unsatisfactory Settlement/Offer
Underwriting - Cancellation
Claim Handling - State Specific
PolicyHolder Service - Premium Refund
PolicyHolder Service - Delays/No Response
PolicyHolder Service - Coverage Question
PolicyHolder Service - Premium Notice/Billing
Underwriting - Premium & Rating
% of All
Count Reasons
13,475
19.50%
11,199
16.21%
7,338
10.62%
3,763
5.45%
3,441
4.98%
2,920
4.23%
2,836
4.10%
2,682
3.88%
2,609
3.78%
2,169
3.14%
Recipient agrees not to market, sell or distribute this data/report without the prior written consent of the NAIC. For reprint
permission please see www.naic.org/jsp/legal_reprints.jsp.
Report reflects data reported from the state insurance departments to the NAIC as of 5/31/2017.
Database: DSPLP
© 1990 - 2017 National Association of Insurance Commissioners. All rights reserved.
Page 2 of 6
Reasons Why Closed Confirmed Consumer Complaints Were Reported
As of May 31, 2017
All Reasons
Code
805
807
808
809
810
815
816
818
819
820
821
822
825
828
829
830
835
836
837
840
845
Underwriting
Underwriting
Underwriting
Underwriting
Underwriting
Underwriting
Underwriting
Underwriting
Underwriting
Underwriting
Underwriting
Underwriting
Underwriting
Underwriting
Underwriting
Underwriting
Underwriting
Underwriting
Underwriting
Underwriting
Underwriting
1101
1103
1104
1105
1107
1110
1113
1115
1118
1120
1121
1122
1123
1125
1126
1129
1130
1131
1132
1133
1134
1135
1136
1137
1138
1139
1140
1141
1142
1143
1144
1145
1146
1147
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
PolicyHolder Service
Database: DSPLP
Reason for Reporting Complaint
Premium & Rating
Dependent Age
Pre-existing Condition
Waiting Periods
Refusal to Insure
Cancellation
Nonrenewal
Credit Report
Redlining
Delays
Forced Placement
Audit Dispute
Unfair Discrimination
Rescission
Surcharge
Endorsement/Rider
Group Conversion
CLUE Reports
MIB Reports
Continuation of Benefits
State Specific
Inadequate Provider Network
Class Action
1035 Exchange
Premium Notice/Billing
Surrender Problems
Cash Value
Accelerated Benefits
Delays/No Response
Policy Delivery
Premium Refund
Nonforfeiture
Viatical Settlement
Payment Not Credited
Coverage Question
Access to Care
Abusive Service
State Specific
Credentialing Delay
Involuntary Termination by Plan
Provider Listing Dispute
Delayed Appeal Consideration
Delayed Authorization Decision
Access to Fee Schedule/Rates
Inadequate Reimbursement Rates
Unfair Negotiation
Premium Subsidy
Wellness Program
Essential Community Provider
Choice of PCP (Primary Care Provider)
Disabled Individuals' Access
MLR (Medical Loss Ratio) Rebate
Language Access
Notice Requirements
Continuity of Care
2017
566
2
11
1
46
1,139
322
13
0
90
9
25
2
19
356
24
4
17
4
34
130
2016
2,278
7
22
12
190
4,188
1,025
26
1
387
24
115
15
51
8,447
92
11
63
13
108
655
2015
2,418
10
21
19
195
4,096
916
30
1
361
29
126
17
34
7,372
86
10
82
11
146
589
2014
2,169
2
14
9
203
3,763
995
34
2
361
19
77
13
46
823
56
6
76
3
107
671
21
0
7
1,015
95
107
2
1,087
93
846
7
0
316
1,142
76
125
614
16
64
36
7
15
4
675
5
15
1
0
7
1
0
0
94
8
80
8
46
3,921
349
295
7
3,449
330
3,215
12
1
1,101
4,301
280
419
2,109
94
248
116
21
86
16
563
21
165
8
7
24
5
0
2
260
49
76
8
23
2,918
311
265
7
2,606
378
3,223
16
0
760
3,265
359
293
1,740
39
231
95
24
59
19
162
14
145
2
0
25
2
0
1
94
48
99
4
26
2,609
245
250
2
2,836
518
2,920
12
0
508
2,682
338
188
1,574
25
243
85
14
44
13
55
18
38
3
0
23
1
2
1
40
21
© 1990 - 2017 National Association of Insurance Commissioners. All rights reserved.
Page 3 of 6
Reasons Why Closed Confirmed Consumer Complaints Were Reported
As of May 31, 2017
All Reasons
Code
Reason for Reporting Complaint
2017
2016
2015
2014
Recipient agrees not to market, sell or distribute this data/report without the prior written consent of the NAIC. For reprint permission please
see www.naic.org/jsp/legal_reprints.jsp
Report reflects data reported from the state insurance departments to the NAIC as of 5/31/2017.
Database: DSPLP
© 1990 - 2017 National Association of Insurance Commissioners. All rights reserved.
Page 4 of 6
Reasons Why Closed Confirmed Consumer Complaints Were Reported
As of May 31, 2017
All Reasons
Code
1001
1002
1003
1004
1005
1006
1007
1009
1010
1012
1013
1015
1017
1018
1019
1020
1021
1022
1025
1028
1030
1035
1036
1037
1038
1039
1040
1041
1042
1043
1044
1045
1046
1047
1048
1049
1050
1051
1052
1053
1054
902
903
904
905
906
908
911
913
915
918
919
922
923
924
926
929
930
931
933
Database: DSPLP
Reason for Reporting Complaint
Adjuster Handling
Prompt Pay
Willing Provider
Provider Availability
Unsatisfactory Settlement/Offer
Preexisting Condition
Medical Necessity
Fraud
PostClaim Underwriting
Subrogation
Comparative Negligence
Denial of Claim
Usual, Customary, Reasonable Charges
Out-of-Network Benefits
Co-pay Issues
Coordination of Benefits
No Preauthorization
PCP Referrals
Delays
Assignment of Benefits
Cost Containment
State Specific
Appeal Non-Compliance
Claim Recoding/Bundling
Recoupment
Annual Limit
Essential Health Benefit
External Review
Internal Appeal
Lifetime Limit
Preventive Care
Pharmacy Benefits
Maternity and Newborn Care
Emergency Services
Mental Health Parity
Maximum Out of Pocket
Ambulatory Patient Services
Hospitalization
Rehabilitative/habilitative Care
Pediatric Care
Laboratory Services
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Claim Handling
Marketing & Sales
Marketing & Sales
Marketing & Sales
Marketing & Sales
Marketing & Sales
Marketing & Sales
Marketing & Sales
Marketing & Sales
Marketing & Sales
Marketing & Sales
Marketing & Sales
Marketing & Sales
Marketing & Sales
Marketing & Sales
Marketing & Sales
Marketing & Sales
Marketing & Sales
Marketing & Sales
Marketing & Sales
Unfair Discrimination
Suitability
Financial Privacy
Misleading Advertising
Health Privacy
Replacement
Unauthorized Entity
Fiduciary/Theft
Misrepresentation
Misappropriation of Premium
Not Appointed w/Company
High Pressure Tactics
Duplication of Coverage
Rebating
Misstatement on Application
Fraud/Forgery
State Specific
Excess Compensation Without Agreement
Failure to Submit Application
2017
783
1,404
2
32
2,806
35
247
18
20
24
112
3,600
136
286
256
99
73
9
3,972
34
37
615
22
22
249
5
7
20
27
0
51
140
17
107
4
26
13
12
13
8
12
2016
2,349
2,569
7
147
8,706
58
585
63
72
126
344
13,418
319
1,011
860
286
471
121
14,323
121
131
1,988
91
84
439
28
42
60
106
1
197
575
61
338
33
87
36
37
41
24
63
2015
2,038
1,270
5
136
8,486
106
617
50
54
103
343
13,353
97
883
866
288
278
64
14,356
159
157
3,188
62
50
232
29
25
31
43
3
127
413
56
219
32
99
18
52
39
31
54
2014
1,354
845
10
113
7,338
125
460
31
30
108
237
11,199
126
546
577
249
179
32
13,475
113
205
3,441
38
43
151
20
13
10
12
5
85
118
12
64
7
40
7
14
10
2
5
1
37
0
25
4
13
5
6
209
21
3
19
22
7
20
25
228
8
6
8
177
4
95
16
110
11
43
759
54
21
86
108
5
105
108
1,128
40
69
9
152
15
92
13
83
19
40
659
62
10
98
77
7
48
86
1,104
57
39
7
187
2
93
11
107
22
47
666
64
13
87
54
4
41
83
1038
27
42
© 1990 - 2017 National Association of Insurance Commissioners. All rights reserved.
Page 5 of 6
Reasons Why Closed Confirmed Consumer Complaints Were Reported
As of May 31, 2017
All Reasons
Code
934
935
936
937
938
Marketing & Sales
Marketing & Sales
Marketing & Sales
Marketing & Sales
Marketing & Sales
Reason for Reporting Complaint
Premiums Misquoted
Other Violation of Insurance Law/Regulation
Adjuster Working for a Company Not Licensed
Using an Unlicensed Name
Summary of Benefits
2017
20
19
1
0
5
2016
91
73
1
2
15
2015
109
60
1
1
39
2014
100
49
1
2
9
Recipient agrees not to market, sell or distribute this data/report without the prior written consent of the NAIC. For reprint permission please
see www.naic.org/jsp/legal_reprints.jsp
Report reflects data reported from the state insurance departments to the NAIC as of 5/31/2017.
Database: DSPLP
© 1990 - 2017 National Association of Insurance Commissioners. All rights reserved.
Page 6 of 6