Accidents and health insurance drew the most complaints in 2024
Poor insurance settlements and delayed claimsoften plague buyers of health and car insurance.
The good news? Complaining often works.
Only 4.1% of complaints against insurers ended with the company's position being upheld in 2024, compared with around 26% of cases ending with the insurer's position overturned or a compromise on an insurance settlement, according to a review of National Association of Insurance Commissioners data by insurance-comparison website ValuePenguin.
The findings show that appeals largely work, ValuePenguininsurance expert Divya Sangameshwarsaid.
"If your insurance company refuses to settle a claim in a way you think is fair or if they drop your coverage without proper reason, you have a right to appeal the companys decision," Sangameshwarsaid. "The benefit of the appeal is that it forces your insurer to tell you why theyve made their decision and they also have to let you know you can dispute their decision."
What are most insurance complaints about?
Claim handling made up the biggest share of complaints about insurance in 2024, accounting for around 65% of cases, ValuePenguin said.
Claim handling included around 22% of complaints about delays and 12% for unsatisfactory settlements or offers.
Companies are required under regulations to respond to and resolve claims promptly, although no timelines are given, Value Penguin said.
Sangameshwar said delays can be because of incomplete or inaccurate documentation or paperwork problems from the insurance claimant.
"However, delays also come from the insurance company themselves, who may delay the process citing a need for further investigation," she said."Or the insurer may be swamped with a high volume of claims which is usually the case in the aftermath of a major natural disaster like a hurricane."
What kinds of insurance get the most complaints?
Accident and health insurance and car insurance drew the most complaints by far in 2024, accountingfor around 37% and 35%, respectively, ValuePenguin said.
Between 2021and 2024, ValuePenguin said accident and health insurance complaints grew around 17% and car insurance complaints increased around 32%.
But complaints rose across the board except for liability insurance, which had a decrease of 31%.
At the more specific coverage level, private passenger car insurance, or personal auto insurance, got the most complaints at around 18% in 2024.
Following private passenger car insuranceare general homeowners insurance at around 10% of complaints and individual accident and health insurance at 9%.
It is important for buyers of homeowners and car insurance to understand their coverage limits and excluded perils to avoid making claims that get denied,Sangameshwar said.
"They should also include insurance in their disaster prep, like making an inventory of all the valuable items in their home to find out how much they stand to lose in a disaster situation and making sure they have enough insurance to cover those losses," she said.
For health insurance,Sangameshwar said claimants should work with patient advocates, experts who help navigate the healthcare system.
Patient advocates can be enlisted for free through the Patient Advocate Foundation.
"Advocates can help policyholders understand their insurance policies, ensure that insurers are honoring their commitments, and assist with appealing denied claims and checking medical billing to see that policyholders arent overcharged," she said.
Tips for filing an insurance complaint
ValuePenguin has the following advice for filing an insurance complaint:
- A complaint requires documentation."Make sure you document everything while dealing with your insurer," Sangameshwar said. "Youll need to fill out a complaint form, submit a detailed account of what happened, and provide supporting documents, emails and a log of phone calls, photographs or screenshots."
- While complaints with your states Department of Insurance are meant to be a last resort, you can sometimes bypass the internal appeal process with your insurer.This could include a scenario where the insurance company isnt complying with a reasonable time frame for an internal appeal (this standard varies by state), or if the insurance company waives its right to an internal review.
- In the case of health insurance claims, a patient facing a life-threatening health crisis can request an expedited internal and external appeal at the same time.Pushing for a faster decision can be critical to accessing coverage for life-saving medicine or helping offset high care costs.
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Posted: 2025-02-12 02:21:16
