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CA Department of Insurance

Consumer Success Stories

As the largest consumer protection agency in California, we at the Department of Insurance take pride in the work that we do every day as we serve the public. This page highlights just some of the success stories resulting from the hard work and dedication by our approximately 1,300 professionals, including the Consumer Services Division, which handles over 200,000 calls a year to our hotline and investigates over 36,000 requests for assistance.

 

WILDFIRES

I have been an attorney in California for about 50 years, specializing in insurance and reinsurance matters. I have known and worked with several of the Insurance Commissioners over the years, but I have never seen one as active in the public interest as Commissioner Jones. He is to be commended for his many positive and beneficial regulatory acts. I also live near the recent fires in Santa Barbara County and personally appreciate his immediate attention to the insurance issues arising from the conflagration.

Thank you. 

- Daniel S., Solvang, CA

 

Just got the best news! My insurer is going to pay out 100% of the personal property claim without a content list!

For me, it was excruciating to try to work on this list because my mother died in the fire. To try and list all her belongings and when/where/how much it all cost (when I have no idea), it was brutal. The loss of my mother has been devastating. To try and do this inventory too, it was just too much to ask.

...I was so relieved, I started to cry. My deep gratitude goes out to the commissioner and your office. Really, you saved me from this awful, traumatic task... it's an added relief not to have to worry about the depreciation and actual value - since I would not be replacing anything. I hope the insurance companies waive the inventory list for the folks southern CA too.

Thank you!

- Jessica T. (Facebook comment left on February 18, 2018)

 

HOMEOWNERS INSURANCE

Dear Insurance Commissioner,

On April 13, 2017, my insurer sent me an unexpected check as a refund on my homeowner's insurance for my policy issued between December 9, 2016-February 13, 2017, "as a result of pending litigation with the California Department of Insurance."

Wow!

Thank you for your hard work! Much appreciated!

- Donna H., Santa Cruz, CA

 

LIFE INSURANCE

It's a shame the majority of our regulatory agencies don't stand up for the consumer the way you do. All the work I put in, along with your help, got my mother's lapsed life Insurance policy of 5 years, reinstated, almost 2 years AFTER, her death. What took almost 2 years to obtain, was stripped from me, in a matter of 2 months.

- Christine M. (Facebook comment left on February 21, 2014)

 

 

HEALTH INSURANCE

As a patient with severe obstructive sleep apnea, and a history of heart failure, I had learned the value of communicating early and often with my medical providers.  When I noticed my sleep quality degrading, despite being a compliant CPAP user, I contacted my primary care physician. My doctor ordered what I had always known as a basic test, namely, an in-lab sleep study to evaluate the issue and to understand what pressure the doctor would order the machine to be set to.  

When my insurance company denied my test as "not medically necessary" I was certain that it was just a misunderstanding, lack of documentation, or some other administrative issue that would be corrected. When my doctor's office tried to resolve this and no progress was made, I began to get concerned. My concern turned to disgust as I quickly realized that my insurance company was denying coverage despite the fact I clearly met their parameters and requirements for the test.  

I was truly facing a large, unorganized, machine of an insurance company that I felt did not value my health, my policy, or the fact that my hard work pays for the policy that was issued. They denied my doctors legitimate order for testing repeatedly, and processed my appeals without any genuine concern for my health and welfare. Unlike the Department of Insurance, when my insurance company "reviewed' my case data, they did not even look at all of the available healthcare records that were in their possession. It was clear that my insurance company was hopelessly lost in understanding me as a patient and rather only saw me as a liability.

The Independent Medical Review (IMR) process was an amazing act of professionalism in my experience. Submitting the case for review was straightforward, and the Department of Insurance communicated with me about the status of my review in a very timely fashion. I was able to submit supporting documentation, as was My insurance company, who submitted their own policies and procedures as well as their various denials. The Department of Insurance had an appropriate resource trained in the area of medicine that was at issue in my case review the relevant documents. When I read the summary from the reviewer, I felt an enormous burden lift, because I realized that finally somebody was listening who was clearly motivated by a positive health care outcome.

The decision to direct my insurer to provide the coverage I was entitled has directly led to me being able to be successfully treated. To me, this means quality of life, and the ability to work so that I can provide for my family. My insurance company was shortsighted and treated me like a number. The Department of Insurance treated me like a human, with dignity, and has empowered me to restore my health!

My wife and children would like to thank everyone at the California Department of Insurance. Obviously for me, being healthy is important. My family means everything to me, and if my insurance company had their way, I am not sure I would be in the best place to take care of them.  

Thank you does not convey it well enough. 

- Tony S.
(Email received February 3, 2014)

 

CONSUMER ASSISTANCE

I work with federal, state and county agencies not only across the country, but across the globe. I personally encounter and interact with public servants at every government level every single business day. I have worked in this role for over 20 years and I must tell you that I can count ON ONE HAND the number of times I have received the level of personal service and dedication to helping us solve our customer's issue that you provided yesterday.

Many, many thanks for your kindness and your service!

Steve E.
Customer Service Leader, Correspondent Network Administration

(e-mail received February 22, 2014)
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