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How do the consumer insurance advocates help Oregonians?
Advocates educate consumers about their rights under the law,
operate a hotline for consumers with questions or complaints about insurer or agent (producer)
practices, and resolve issues before they lead to further consumer harm.
Our advocates answer about 15,000 insurance questions a year
and investigate more than 4,000 complaints against insurance companies. We recover about
$2 million annually on behalf of consumers. Our hotline generally is available from 8 a.m.
to 5 p.m. Monday through Friday. Call 503-947-7984 or (toll-free) 1-888-877-4894. Or, e-mail
questions to cp.ins@state.or.us
Advocates do not act as an attorney for a person. Most consumers
are helped through our informal efforts to resolve matters between consumers and insurers
or agents. The main purpose of our consumer complaint process is to identify and eliminate
the most serious threats to Oregon consumers.
The consumer calls we receive are critical to protecting all
insurance-buying consumers. Advocates refer potential violations of insurance law to our
investigators for possible enforcement action. The Oregon Insurance Division can fine companies
or agents that break the law and/or revoke their licenses. Based on consumer complaints,
the advocates may detect areas of the law that need to be changed to give consumers additional
protections. They may recommend creation of educational materials and outreach to consumer
groups on a particular topic.
Even though our advocates may not always be able to help you
resolve your complaint, your calls assist other Oregonians by identifying issues of concern
and potential problems facing the insurance-buying public.
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What happens when I file a complaint?
We assign your complaint to an advocate who contacts the insurance
company or agent on your behalf. This is usually done by sending a copy of your complaint
with a cover letter. We're looking for an explanation for each of your concerns and any supporting
documentation for the position taken by the insurance company. The company or agent must
respond within three weeks. The advocate reviews the material provided by the company or
agent, determines whether additional information is needed, follows up if necessary, and
advocates on behalf of the consumer for a resolution to the problem.
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How long does it take to complete the process?
Sometimes it is just a matter of a few days or weeks but it
can take longer depending on the issues. Most complaints are resolved within 60 days.
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Do you handle all kinds of insurance issues?
We handle most lines of insurance including auto, homeowner,
health, life, annuities, long-term care and even some of the more unusual lines like pet
insurance. We do not have regulatory authority over Medicare, so we work with our sister
agency, the Senior Health Insurance Benefits Assistance (SHIBA) program, to get your questions
answered. Worker's compensation issues are handled by the Worker's Compensation Division.
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Are you usually able to get a good result for the consumer?
Most consumers - but not all - are helped through our efforts
to informally resolve disputes. Outcomes range from a better understanding of the situation
to getting a claim paid. Consumers who are unhappy with the results we obtain may want to
contact an attorney.
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Can't you just tell the insurance company what to do?
Our advocates are passionate and persuasive, and most insurance
companies and agents cooperate with us. However, some issues don't fall under our jurisdiction.
For example, we may get a complaint about a car accident and the issues might be who is at
fault or how much should be paid. We will get involved to be sure the insurance companies
follow the law and the consumer is aware of his or her rights and options. However, the court
system determines fault and damages rests with the court system. Also, we can not force a
company to pay claims, to cover a medical procedure, or to refund premiums if the company
is following the law and its insurance contract.
We are not attorneys and we can not act as a legal representative.
We can not recommend an insurance company or agent. We can help you find information about
whether a company or agent is licensed in Oregon, a company's complaint history and its financial
soundness.
