Transcript
Page 1: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Insurance Consumer Affairs ExchangeMarian Drape

Information Systems DivisionMarket Information Systems Team

September 30, 2008

NAIC Complaint DataWhat Comes InWhat Goes Out

Page 2: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

CMSCIS

I-SITE

Closed Consumer Complaints

Page 3: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Agenda• What Comes In

– Where do we get complaint data?– When do we get complaint data?– What data do we get?– What do we do with complaint data?

• What Goes Out– CMS– CIS– I-SITE

• Questions?

Page 4: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

074097165

A Complaint Is…

Any *written communication that expresses dissatisfaction

with a specific person or entitysubject to regulation

under the state's insurance laws.

Market Regulation and Consumer Affairs (D) Committee, June 13, 2006

*Note: An oral communication, which is subsequently converted to a written form, will meet the definition of a complaint for this purpose.

Page 5: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

What Comes In

Page 6: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Where do we get complaint data?• State insurance departments• Voluntary• Electronic transmission

Page 7: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

When do we get data?

• Monthly - 2nd business day• Daily

Page 8: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

What data do we get?

• Closed• Consumer • Confirmed/Unconfirmed• Firm/Individual• Medicare• Types of Insurance

Page 9: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

NAIC Standard Complaint Data• Complaint identification• Complaint against• Complainant/Insured information• Type of coverage• Reason for complaint• Disposition

Page 10: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Page 11: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Complaint Identification

• State• State complaint number• Date opened• Date closed

Page 12: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Complaint Against

• Name• Address• NAIC company code• FEIN• National producer number• Date of birth

Page 13: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Complainant/Insured

• Zip code• Age group• Complainant type

– Insured, beneficiary, military personnel

Page 14: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

First Level Coverage

• Auto (8)• Fire, Allied Lines, CMP (7)• Homeowners (7)• Accident & Health (4)• Life & Annuity (7)• Liability (6)• Miscellaneous (18)

Page 15: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Second Level Coverage

• Auto (17) • Fire, Allied Lines, & CMP (7)• Homeowners (13)• Accident & Health (24)• Life & Annuity (11)• Liability (24)• Miscellaneous

Page 16: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Reasons

• Underwriting (29)• Policyholder Service (22)• Claim Handling (36)• Marketing & Sales (30)

Page 17: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Dispositions

• 45 disposition codes• Determines confirmed complaint

– At least one disposition is confirmed

Page 18: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Dispositions

• Unconfirmed dispositions– Unable to assist– Cancellation upheld– Non-renewal upheld– No action requested/required– Referred to proper agency/section– Company in compliance– Company position upheld– No jurisdiction– Insufficient information

Page 19: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

What do we do with the data?• Validate • Load• Quality• Present

Page 20: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Validate

• Form and format • Entity• Error resolution

– NAIC Transmission Viewer– Internal NAIC applications

Page 21: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Load

• All valid data• CDS – Complaints Database System

Page 22: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Complaints Database System• 199

1• 199

8

• 2008

– CDS operational– Expansion of coverage types,

reasons, dispositions– MAP (D) Working Group review

of complaint handling and reporting

Page 23: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Complaints Database System• 10 year retention• 2,000,000+ complaints• 22,000+ Medicare complaints

Page 24: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Quality

• Frequency– Monthly

• Currency– Within last month

• Accuracy• Completeness

Page 25: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Quality

• Firm/Individual• Life, Health & Annuity/Property &

Casualty• Confirmed/Unconfirmed• Medicare• Use of ‘other’• Error rate

Page 26: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Quality

• Market State Audit System– Compare state data to data in CDS– Identify discrepancies– Suggest resolutions

Page 27: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Quality

• MIS Metrics– Counts– Timeliness– Error rates– Types of complaints

Page 28: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Metrics

Page 29: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Quality

• Participating state reports– Counts– Earliest/most recent submission dates– Earliest/most recent closed complaint

dates

Page 30: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

What Goes Out

Page 31: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

CMS CIS I-SITE

Who has access?

Federal governmen

tPublic

State insurance regulators

Types? Medicare

Confirmedonly

AllRisk bearing entities

Retention?

3 years plus

current10 years

Page 32: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Complaints in CMS

• Centers for Medicare & Medicaid Services

• State’s compliance with OBRA 1990• Quarterly• Data sent from NAIC’s Government

Relations Office

Page 33: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Complaints in CIShttp://www.naic.org/cis/index.do

Page 34: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Complaints in CIS

• Closed• Consumer• Risk bearing entities• Confirmed

– At least one disposition is confirmed• Three years (plus current, if

applicable)• Voluntarily reported by states• Public data

Page 35: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Complaints in CIS

• Complaints against a selected risk bearing entity– 4 reports

• Aggregate consumer complaints reports– 3 reports

Page 36: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Complaints in CIS

• Complaints against a selected risk bearing entity– Counts by state– Counts by code– Trend– Ratio

Page 37: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Counts by State Report• For selected company• By state• Filters

– By year– By complainant

Page 38: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Counts by Code Report• For selected company• By code

– Coverage– Reason– Disposition

• Filters– By year– By complainant

Page 39: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Trend Report

• Change in complaint counts– Total– Percent

• Three year trend• Filters

– By complainant

Page 40: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Ratio Report

• Company’s complaint index

• National median complaint index

• Filters– By year– By insurance type

Page 41: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Complaints in CIS

• Aggregate reports– By type of insurance– By reason– By disposition

• Updated monthly

Page 42: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Complaints by Type of Insurance• Summary

– Seven primary coverage types

– By year

• Detail– All secondary

coverage types– By year

Page 43: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Complaints by Reason

• Summary– Top ten reasons – By year

• Detail– All reasons– By year

Page 44: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Complaints by Disposition

• Counts• By year

Page 45: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Complaints in I-SITE

• All• 10 years• Voluntarily reported by states• Regulator only

Page 46: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Complaints in I-SITE

• Complaints against a selected entity– Counts by state– Counts by code– Trend– Index

• Summary • Market analysis

Page 47: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Count, State, Trend Reports

• States/regions• Complainant• Role code

• Medicare supplement policy

• Date range

More selection criteria

Page 48: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Complaint Index Report

• Selection criteria– States/regions– Policy type– Premium year– Complaint year

• Results for confirmed and total (complete) complaints

Page 49: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Complaint Summary Report

• List of risk bearing entities

• Complaint and market share statistics

• Selection criteria– Policy types– By state or region– Comparison to other

states or regions– All or confirmed

Page 50: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Using Complaints in I-SITE• Market analysis• Coordination with other states• Target insurance company exams• Compare complaints with premium

volume• Compare complaints with other entities • Trending of business practices• Identify need for regulatory action• Public disclosure of complaints data

Page 51: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

CMSCIS

I-SITE

Closed Consumer Complaints

Page 52: © 2008 National Association of Insurance Commissioners Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information

© 2008 National Association of Insurance Commissioners

Marian Drape

816.783.8602

[email protected]


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