Date: June 1, 2004
For more information contact: Eileen Mallow, Assistant Deputy Commissioner, (608) 266-7843 or eileen.mallow@wisconsin.gov

Madison, WI--According to the "2003 Insurance Complaints and Administrative Actions" report, nearly 8,000 consumers contacted the Office of the Commissioner of Insurance (OCI) last year to file a complaint. The annual report issued by OCI lists companies with at least six complaints received in 2003 and with a ratio of complaints per $100,000 of premium that exceed the average for their line of insurance. In 2003, OCI assisted consumers who filed complaints in recovering nearly $5 million from insurers in the form of claims that would not have otherwise been paid.

"It pays to contact OCI with your insurance problem or question," said Jorge Gomez, Commissioner of Insurance. "Our office is a place to turn if you can't get answers somewhere else. We're here to help and we often recover money for consumers."

According to the report, OCI took 158 administrative actions against insurance companies last year and demanded $393,672 in forfeitures. In addition, 181 agent licenses were denied, revoked, surrendered, or suspended accounting for another $176,472 in forfeitures.

The report categorizes complaints by insurance type into four areas: 1) auto, 2) homeowner's, farmowner's and tenant's, 3) accident and health, and 4) life and annuities. Of the agency's 7,960 complaints, the type of coverage generating the most complaints was accident and health (4,763 complaints), while the least was life and annuities (816). The vast majority of complaints concerned claim handling.

"All health plans in Wisconsin are required to have an internal grievance process to resolve complaints such as claim handling disputes. The first step in the grievance process should be to contact the insurer, but if that process fails to produce an amicable resolution, I would encourage everyone to contact OCI," said Gomez.

Although OCI received 7,960 total complaints in 2003, only the 7,024 complaints requiring further investigation were used to calculate the ratios in the report. Complaints are defined by OCI as "a written communication received by the Commissioner's Office that indicates dissatisfaction with an insurance company or agent."

While it is a useful tool in evaluating certain companies, the 2003 complaints report is only one source of information and the number of complaints does not reflect OCI's final determination on whether there has been a violation of the law. However, even when complaints do not involve violations of the law, they may indicate something about company communications with policyholders, deficiencies in policy design or agent training. OCI receives many complaints that involve factual disputes where, in the absence of a court determination, definitive judgments on the factual dispute and violations of the law cannot be made. Consumers are encouraged to use the information in the "2003 Insurance Complaints and Administrative Actions" report along with other information available on insurance companies, such as their financial strength or recommendations from family members or friends, to help them make well-informed buying decisions.

Consumers can reach OCI by calling 1-800-236-8517, e-mailing ociinformation@wisconsin.gov, or by writing OCI, P. O. Box 7873, Madison, WI 53707-7873. Complaint forms can be obtained from OCI's Web site at http://oci.wi.gov.

Created by the legislature in 1871, Wisconsin's Office of the Commissioner of Insurance (OCI) was vested with broad powers to ensure that the insurance industry responsibly and adequately met the insurance needs of Wisconsin citizens. Today, OCI's mission is to lead the way in informing and protecting the public and responding to its insurance needs.