Ohio, Missouri Insurance Departments Return Tens of Millions in Claims Payouts to Consumers

The Ohio Department of Insurance helped recover $30.4 million for insureds in 2017 and the Missouri Department of Insurance helped consumers receive an extra $16.8 million in claims payments last year, insurance regulators in both states reported.

The ODI said it received 5,874 complaints from consumers related to insurance last year. Claim denial was the leading complaint reason and health insurance was the top coverage type complaint.

In Missouri, the department’s Consumer Affairs Division handled approximately 35,000 consumer contacts, received 3,574 formal complaints and returned over $8.5 million to Missourians. The department’s Market Conduct Section, which focuses on identifying and resolving systemic issues, recovered more than $8.3 million for consumers.

In some instances, market conduct actions may originate from consumer complaints that have been filed with the department’s Consumer Affairs Division. In other instances, the issues are identified through monitoring insurance company activities in the insurance marketplace.

Health insurance generated the largest number of complaints in Missouri — 1,270. Those included concerns about a company determining that a prescription was not medically necessary or a consumer learning that his or her coverage had been terminated just days prior to a scheduled procedure.

The Missouri department’s Consumer Affairs Division conducted an additional review in each of these cases and a needed drug was approved resulting in an over $112,000 recovery for the consumer and a reinstatement of a policy when it was most needed.

The Ohio Department of Insurance compared consumer complaints in that state with national data collected by the National Association of Insurance Commissioners (NAIC). The comparison is illustrated in the tables below.