TDI Complaint Process

1
Property
Texas Department of InsuranceProperty Casualty
Compliance WorkshopOctober 30, 2006
Casualty
2006
Compliance
Conference

• TDI Complaint Process
• Valerie Brown, Director
• Complaints Resolution
• Consumer Protection

Texas Department
of Insurance
2
Inquiry vs. Complaint
Property
Casualty
2006
Compliance
Conference

• A request for insurance information from an
  external customer received during business hours
• Customers include
• individual insurance consumers
• business consumers
• regulated entities
• state agencies
• legislators

Texas Department
of Insurance
3
Property
What is a Complaint?
Casualty
2006
Compliance
Conference
any written communication primarily expressing
a grievance TIC Section 542.005(a)
Texas Department
of Insurance
4
TDI Complaint Process
Property
Casualty
2006
Compliance
Conference

• Complaints are received at TDI via
• Regular, certified, overnight mail
• Fax
• Walk-in consumer
• E-mail
• On-line complaint form
• Complaints are input into TDI Complaint Inquiry
  System (CIS)
• Acknowledgment letter sent to complainant
• Inquiry letter to company requesting specific
  information on complaint
• Confirmation on type of coverage
• Evidence of Coverage regarding issue
• Correspondence exchanged
• Claim information

Texas Department
of Insurance
5
Property
Casualty

• Carriers have 10 days to respond to TDI
  inquiries, per Texas Insurance Code Section
  38.001
• Response is received from carrier and/or agent
  and matched to the complaint
• Response is reviewed by an insurance specialist
• Is the response sufficient in depth and scope?
• Can the complaint be resolved?
• Additional information requested, if needed
• Complaint closed
• Closing correspondence to complainant with copy
  of company and/or agent response
• Copy of closing correspondence to company and/or
  agent
• Complaint closed in CIS
• Is complaint justified or unjustified?
• Should complaint be referred to Enforcement?
• Complaints can be reopened with additional
  information and/or continued violation of rule or
  statute

2006
Compliance
Conference
Texas Department
of Insurance
6
All PC Complaints Closed by Consumer
ProtectionFiscal Year 2006
Property
Casualty
2006
Compliance
Conference
Texas Department
of Insurance
One complaint may be coded with one or more
reasons.
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Property
PC Complaints Annual WorkloadFY 2006
Casualty
2006
Compliance
Conference

• Total number of complaints received
  14,460
• Total number of complaints closed
  10,530
• Total number of complaints justified
  4,655
• Average number of days to resolve complaint
  35.54
• Monies recovered for consumers
  41 million

Texas Department
of Insurance
8
What Makes a Complaint Justified?
Property
Casualty
2006
Compliance
Conference

• An apparent violation of a policy provision,
  contract provision, rule or statute
• A valid concern that a prudent layperson would
  regard as a practice or service that is below
  customary business or medical practice

Texas Department
of Insurance
9
Examples of Justified Complaints
Property
Casualty
2006
Compliance
Conference

• Claim was denied when it should have been paid
• Claim was not paid timely and/or according to TIC
  Section 542.051-542.060
• Policy was not cancelled according to contract
  provisions, rules or statutes
• Untimely responses to TDI

Texas Department
of Insurance
10
Preventing Complaints to TDI
Property
Casualty
2006
Compliance
Conference

• Assure customer service and claims staff are well
  informed and communicate effectively
• Maintain adequate staff to respond to customers
• Monitor call times
• Respond to complaints timely

Texas Department
of Insurance
11
Insurers Response to TDI
Property
Casualty
2006
Compliance
Conference

• Maintain a complaint log (record)
• Respond in 10 days
• Use document ID throughout correspondence
• Provide extension request in writing per
  Commissioners Bulletin 0040-00
• Send final response to TDI one time
• via email
• via fax
• direct response to appropriate TDI area or staff
  member
• Forward or return misdirected complaints

Texas Department
of Insurance
12
Complaint Web Data
Property
Casualty
2006
Compliance

• TDI maintains information regarding complaints in
  a computerized tracking system (CIS)
• Selected information from CIS is included in the
  Internet Complaint Information System (ICIS)
• Information included in ICIS is not the entire
  universe of available complaint information
• Other information regarding complaints may be
  obtained under the Texas Public Information Act
• Categories of complaint information
• Those most often requested
• The type of information generally considered most
  useful
• ICIS contains only closed complaints
• Information in ICIS will be updated at least
  quarterly
• If a closed complaint is reopened, the complaint
  will be removed when ICIS is updated and will
  reappear on the next update after the complaint
  is reclosed.

Conference
Texas Department
of Insurance
13
What to Expect From ICIS
Property
Casualty
2006
Compliance
Conference

• Most TDI closed complaints by quarter
• More than 55,000 auto, home, health, and other
  insurance-related complaints
• 15 categories of data from company name to type
  of complaint
• Requirements
• A spreadsheet or database program to view files
• A computer hard drive, NOT a floppy disk for
  saving files

Texas Department
of Insurance
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Resources
Property
Casualty
2006
Compliance
Conference

• Website
• www.tdi.state.tx.us
• Valerie Brown, CPCU
• Director - Complaints Resolution, Consumer
  Protection
• 512-463-6503
• Toll Free Information
• 1-800-252-3439

Texas Department
of Insurance