insurance consumer affairs exchange marian drape information systems division
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NAIC Complaint Data What Comes In What Goes Out. Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information Systems Team September 30, 2008. Closed Consumer Complaints. CMS. I-SITE. CIS. Agenda. What Comes In Where do we get complaint data? - PowerPoint PPT PresentationTRANSCRIPT
© 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
© 2008 National Association of Insurance Commissioners
CMSCIS
I-SITE
Closed Consumer Complaints
© 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?
© 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.
© 2008 National Association of Insurance Commissioners
What Comes In
© 2008 National Association of Insurance Commissioners
Where do we get complaint data?• State insurance departments• Voluntary• Electronic transmission
© 2008 National Association of Insurance Commissioners
When do we get data?
• Monthly - 2nd business day• Daily
© 2008 National Association of Insurance Commissioners
What data do we get?
• Closed• Consumer • Confirmed/Unconfirmed• Firm/Individual• Medicare• Types of Insurance
© 2008 National Association of Insurance Commissioners
NAIC Standard Complaint Data• Complaint identification• Complaint against• Complainant/Insured information• Type of coverage• Reason for complaint• Disposition
© 2008 National Association of Insurance Commissioners
© 2008 National Association of Insurance Commissioners
Complaint Identification
• State• State complaint number• Date opened• Date closed
© 2008 National Association of Insurance Commissioners
Complaint Against
• Name• Address• NAIC company code• FEIN• National producer number• Date of birth
© 2008 National Association of Insurance Commissioners
Complainant/Insured
• Zip code• Age group• Complainant type
– Insured, beneficiary, military personnel
© 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)
© 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
© 2008 National Association of Insurance Commissioners
Reasons
• Underwriting (29)• Policyholder Service (22)• Claim Handling (36)• Marketing & Sales (30)
© 2008 National Association of Insurance Commissioners
Dispositions
• 45 disposition codes• Determines confirmed complaint
– At least one disposition is confirmed
© 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
© 2008 National Association of Insurance Commissioners
What do we do with the data?• Validate • Load• Quality• Present
© 2008 National Association of Insurance Commissioners
Validate
• Form and format • Entity• Error resolution
– NAIC Transmission Viewer– Internal NAIC applications
© 2008 National Association of Insurance Commissioners
Load
• All valid data• CDS – Complaints Database System
© 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
© 2008 National Association of Insurance Commissioners
Complaints Database System• 10 year retention• 2,000,000+ complaints• 22,000+ Medicare complaints
© 2008 National Association of Insurance Commissioners
Quality
• Frequency– Monthly
• Currency– Within last month
• Accuracy• Completeness
© 2008 National Association of Insurance Commissioners
Quality
• Firm/Individual• Life, Health & Annuity/Property &
Casualty• Confirmed/Unconfirmed• Medicare• Use of ‘other’• Error rate
© 2008 National Association of Insurance Commissioners
Quality
• Market State Audit System– Compare state data to data in CDS– Identify discrepancies– Suggest resolutions
© 2008 National Association of Insurance Commissioners
Quality
• MIS Metrics– Counts– Timeliness– Error rates– Types of complaints
© 2008 National Association of Insurance Commissioners
Metrics
© 2008 National Association of Insurance Commissioners
Quality
• Participating state reports– Counts– Earliest/most recent submission dates– Earliest/most recent closed complaint
dates
© 2008 National Association of Insurance Commissioners
What Goes Out
© 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
© 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
© 2008 National Association of Insurance Commissioners
Complaints in CIShttp://www.naic.org/cis/index.do
© 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
© 2008 National Association of Insurance Commissioners
Complaints in CIS
• Complaints against a selected risk bearing entity– 4 reports
• Aggregate consumer complaints reports– 3 reports
© 2008 National Association of Insurance Commissioners
Complaints in CIS
• Complaints against a selected risk bearing entity– Counts by state– Counts by code– Trend– Ratio
© 2008 National Association of Insurance Commissioners
Counts by State Report• For selected company• By state• Filters
– By year– By complainant
© 2008 National Association of Insurance Commissioners
Counts by Code Report• For selected company• By code
– Coverage– Reason– Disposition
• Filters– By year– By complainant
© 2008 National Association of Insurance Commissioners
Trend Report
• Change in complaint counts– Total– Percent
• Three year trend• Filters
– By complainant
© 2008 National Association of Insurance Commissioners
Ratio Report
• Company’s complaint index
• National median complaint index
• Filters– By year– By insurance type
© 2008 National Association of Insurance Commissioners
Complaints in CIS
• Aggregate reports– By type of insurance– By reason– By disposition
• Updated monthly
© 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
© 2008 National Association of Insurance Commissioners
Complaints by Reason
• Summary– Top ten reasons – By year
• Detail– All reasons– By year
© 2008 National Association of Insurance Commissioners
Complaints by Disposition
• Counts• By year
© 2008 National Association of Insurance Commissioners
Complaints in I-SITE
• All• 10 years• Voluntarily reported by states• Regulator only
© 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
© 2008 National Association of Insurance Commissioners
Count, State, Trend Reports
• States/regions• Complainant• Role code
• Medicare supplement policy
• Date range
More selection criteria
© 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
© 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
© 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
© 2008 National Association of Insurance Commissioners
CMSCIS
I-SITE
Closed Consumer Complaints