1. Pennsylvania Insurance Department Complaint Handling
Carolyn M. Morris
Director
Bureau of Consumer Services

2. Pennsylvania Insurance Department Complaint Handling
Office of Market Regulation
Bureau of Market Actions
Bureau of Consumer Services
Bureau of Enforcement

3. Pennsylvania Insurance Department Complaint Handling
Bureau of Consumer Services
Health Insurance
Division
Life Insurance
P&C
Intake
Unit

4. Pennsylvania Insurance Department Complaint Handling
Insurance Marketplace
What is a complaint?
Complaint
..An expression of grievance or dissatisfaction associated with a licensee of the Department

5. Pennsylvania Insurance Department Complaint Handling
Confirmed Complaint
A complaint is one in which the insurer, producer or other regulated entity is determined to have committed any violation of an applicable state insurance law or regulation, a federal requirement that the we have the authority to enforce, or a term or condition of the insurance policy or certificate. A confirmed complaint also includes where the complaint and the entity’s response, considered together, indicates that the entity was in error. (i.e. market conduct note, market conduct referral, enforcement referral)

6. Pennsylvania Insurance Department Complaint Handling
How Are Complaints Received and Tracked?
Consumer Portal
Fax
Mail
In Person
NAIC
Standard
Coding
System

7. Pennsylvania Insurance Department Complaint Handling
What is the complaint handling process?
Complaint

8. Pennsylvania Insurance Department Complaint Handling
How is Complaint Information Shared?
Public Information Requests (Aggregate)
NAIC Complaint Data System
Complaint Comparison Tool
Insurer Complaint Reconciliation Tool
Market Analysis
Market Regulation Meetings

9. Pennsylvania Insurance Department Complaint Handling
What’s In the Future?
Insurer Portal

10. Pennsylvania Insurance Department Complaint Handling 2015 Total – 12,329

11. Pennsylvania Insurance Department Complaint Handling 2015 Complaints By Problem Type
LINE OF BUSINESS
CLAIMS HANDLING
MARKETING AND SALES
POLICYHOLDER SERVICES
UNDERWRITING
Grand Total
HEALTH
2092
111
984
546
3733
AUTO
1610 74
535
2382
4601
FIRE
106 17 25
236
384
HOME
583 38
112
1365
2098
LIAB 81 4 11 50
146
LIFE
195
163
597
153
1108
MISC
129 46 54 60
289
4796
453
2318
4792
12359

12. Pennsylvania Insurance Department Complaint Handling
Questions?