February 08, 2016

Missouri Department of Insurance helped to obtain millions of dollars for citizens and schools in 2015

Department recovered more than $15.5 million for consumers and obtained $6.2 million for public schools in 2015

Jefferson City, Mo. - The Missouri Department of Insurance helped to obtain millions of dollars for citizens and schools in 2015 through regulatory intervention and penalties against insurance companies.

The department also worked to overturn improper decisions made by health insurance companies, including a company that had reduced ABA treatment for a 13-year-old with autism without explanation. After the Department of Insurance intervened and referred the family's complaint to an external review on behalf of the boy and his family, the health insurer's decision to reduce the ABA treatment was overturned by an Independent Review Organization. The health insurer reinstated the full coverage for the boy's treatment and financially compensated the family.

"Missourians have a right to appeal a health insurance company's decision to deny medical treatment," said Missouri Department of Insurance Director John M. Huff. "The Department of Insurance is here to help Missourians find a solution if they reach an impasse with their health insurer."

In 2015, the Missouri Department of Insurance handled approximately 36,000 consumer contacts and received 4,189 formal complaints. Health insurers were the biggest driver of complaints with 1,609. The second leading driver was auto insurance with 845 complaints. Insurance agent investigations drew 766 complaints and life insurance and annuities had 474 complaints.  

The top reason for complaints was claim denial with 1,056. Delays of claim processing had 830 complaints and unsatisfactory settlement offer had 356 complaints.

The department returned more than $15.8 million either through consumer complaints or regulatory settlements. An additional $6.2 million in fines went to the Missouri School Fund in 2015.

Some notable market conduct actions include:

  • The department fined a Medicare supplement insurer $150,000 after it alleged the insurer discouraged producers from accepting Medicare Supplement applications from unhealthy consumers during open enrollment and guarantee issue periods. During the open enrollment/guarantee issue periods, applicants for Medicare Supplement coverage are required to be accepted regardless of health condition and without any underwriting.
  • The department fined an auto insurer $80,000 after the department alleged the insurer failed to provide anti-theft discounts on vehicles that qualified for the discounts between 2008-2015. In addition to the fine, the insurer paid refunds to impacted Missourians.

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.