February 16, 2015

Insurance Department continues to protect Missourians: Recovers nearly $25 million for consumers in 2014

Investigation led to largest market conduct settlement in state history

Jefferson City, Mo.  - The Missouri Department of Insurance concluded 2014 by recovering approximately $11.7 million for consumers, who filed complaints against their insurance companies and an additional $12.7 million for Missourians through regulatory, market conduct settlements.

"Returning nearly $25 million to Missourians in 2014 is a strong testament to our department's commitment to protecting consumers," said Department Director John M. Huff. "If a consumer has questions about their insurance or reaches an impasse with their insurance company, they should call us."

The Consumer Affairs Division handled some 40,000 consumer contacts and received 4,263 formal complaints in 2014. Health insurance was the biggest driver of complaints with 1,606. That is up from 916 complaints in 2013. The second leading driver was auto with 781 complaints. Agent investigations drew 657 complaints and life and annuities had 483 complaints.  

The top reason for complaints was claim denial with 1,071. Delays of claim processing had 855 complaints and unsatisfactory settlement offer had 409 complaints.

The Market Conduct Regulation Division recovered $12.7 million in consumer restitution and collected $1.4 million in fines for the Missouri school fund in 2014. These amounts resulted from 44 examinations or investigations into the conduct of insurers which were resolved in 2014. The insurers also were required to take corrective actions to comply with Missouri laws and regulations and, where appropriate, also included consumer restitution.   

The department reached a $7.8 million regulatory settlement with Healthy Alliance Life Insurance Company and HMO Missouri, Inc, subsidiaries of Anthem BlueCross BlueShield of Missouri. A market conduct examination alleged some policyholders were charged materially more premium than other consumers with substantially equivalent health plans. The settlement is the largest settlement of a Missouri market conduct examination by the department. 

For the examinations and investigations resolved in 2014, the Market Regulation Division alleged companies: 

  • Made misleading, deceiving or untrue statements.
  • Misrepresented policy provisions.
  • Charged different premiums for substantially equivalent coverage.
  • Failed to pay claims in accordance with policy provisions.
  • Failed to provide coverage for mandated benefits.
  • Failed to promptly pay claims.

Enforcement and market conduct actions are taken after an investigation or examination reveals potential or actual violations of Missouri statutes or regulations and conclude with the issuance of a consent order, a settlement agreement, or an order and adjudication.

A comprehensive list of enforcement and market conduct actions taken by the department is available on the department's website. Consumers with complaints or questions about their insurance agent or company can call the department's Insurance Consumer Hotline at 800-726-7390 or visit insurance.mo.gov.