Download ppt - © 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


CMSCIS

I-SITE

Closed Consumer Complaints


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?


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.


What Comes In


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


When do we get data?

• Monthly - 2nd business day• Daily


What data do we get?

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


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



Complaint Identification

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


Complaint Against

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


Complainant/Insured

• Zip code• Age group• Complainant type

– Insured, beneficiary, military personnel


First Level Coverage

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


Second Level Coverage

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


Reasons

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


Dispositions

• 45 disposition codes• Determines confirmed complaint

– At least one disposition is confirmed


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


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


Validate

• Form and format • Entity• Error resolution

– NAIC Transmission Viewer– Internal NAIC applications


Load

• All valid data• CDS – Complaints Database System


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


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


Quality

• Frequency– Monthly

• Currency– Within last month

• Accuracy• Completeness


Quality

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

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


Quality

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


Quality

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


Metrics


Quality

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

dates


What Goes Out


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


Complaints in CMS

• Centers for Medicare & Medicaid Services

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

Relations Office


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


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


Complaints in CIS

• Complaints against a selected risk bearing entity– 4 reports

• Aggregate consumer complaints reports– 3 reports


Complaints in CIS

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


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

– By year– By complainant


Counts by Code Report• For selected company• By code

– Coverage– Reason– Disposition

• Filters– By year– By complainant


Trend Report

• Change in complaint counts– Total– Percent

• Three year trend• Filters

– By complainant


Ratio Report

• Company’s complaint index

• National median complaint index

• Filters– By year– By insurance type


Complaints in CIS

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

• Updated monthly


Complaints by Type of Insurance• Summary

– Seven primary coverage types

– By year

• Detail– All secondary

coverage types– By year


Complaints by Reason

• Summary– Top ten reasons – By year

• Detail– All reasons– By year


Complaints by Disposition

• Counts• By year


Complaints in I-SITE

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


Complaints in I-SITE

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

• Summary • Market analysis


Count, State, Trend Reports

• States/regions• Complainant• Role code

• Medicare supplement policy

• Date range

More selection criteria


Complaint Index Report

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

• Results for confirmed and total (complete) complaints


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


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


CMSCIS

I-SITE

Closed Consumer Complaints


Marian Drape

816.783.8602

[email protected]