Treated Unfairly by Your Insurance Company? Try This Roadmap to Fix the Problem

NEW YORK, NY (03/10/2010)(readMedia)-- Sometimes it pays to complain. Last year, more than 7,700 New Yorkers who believed they were treated unfairly by their insurance companies received $32.3 million in payments for claims initially denied. Insurance coverage was restored for thousands of other consumers who didn't take no for an answer.

Who were these consumers and how did they turn the tables?

They were among the more than 264,000 New Yorkers who contacted the New York State Insurance Department asking for help. In many instances, these people received help from Insurance Department representatives who were able to answer their questions over the phone. In other instances, consumer problems resulted in investigations by the Department.

Last year, consumer complaints led to the filing of approximately 60,000 cases that were formally investigated.

One of the cases was filed by a North Syracuse woman whose insurer refused to cover her prescription drugs. Another case involved a Rochester woman sold health insurance by a telemarketer who grossly inflated its value. Another case involved a Watertown area consumer whose homeowners' insurance was improperly cancelled.

These cases had several things in common. First, these consumers had legitimate complaints. Second, they tried to resolve their differences with their insurers by themselves. Third, when they were unable to do so, they contacted the Insurance Department's Consumer Services Bureau by phone, e-mail or regular mail.

While most insurers try to do the right thing, there are always exceptions. So, what should consumers do when they believe they have been treated unfairly?

Here's one roadmap consumers should consider:

Read and Understand Your Policy – Your policy is the contract between you and your insurer. It specifies what is covered under your policy and to what extent. Your policy also specifies exclusions that aren't covered.

Keep Detailed Records – Put the facts of your case on paper and make sure you record events and conversations with others with specific details, especially when you are filing a claim.

Work with Your Insurer – Communicate the facts of your claim with your insurance agent, broker or company. If you don't get a satisfactory answer from your agent, talk with his or her boss or contact the insurance company. Keep good notes on what was said to you, by whom and when. If your claim was denied, make sure you get it from your insurer in writing.

Contact the Consumer Services Bureau – If you still believe you are being treated unfairly, contact the Insurance Department's Consumer Services Bureau. The best way to do this is by filing a written complaint using the online complaint form on the Department's website, www.ins.state.ny.us. If you don't have a computer, send a letter or call the Bureau, which employs trained representatives who investigate complaints and work with consumers and insurers to resolve them.

Consumers who need help should consult the Department's website, www.ins.state.ny.us, which contains extensive information on all types of insurance, including Q&As consumers will find helpful. Consumers can contact the Consumer Services Bureau using the online complaint form on the website, or by writing New York Insurance Department, Consumer Services Bureau, One Commerce Plaza, Albany, NY 12257. Consumers may speak with Bureau personnel from 9 a.m. to 4:30 p.m., Monday through Friday toll-free at 800-342-3736.

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