Complaints Database System

To access complaints information:

1. Search for an individual or firm using  Business Entity search, Individual Entity search or a Company/Firm Search.
2. The Results page displays a list of entities that match the criteria entered on the search page.
3. Click the Complaints link in the Available Information section for the specific entity. 
4. The CDS Disclaimer will display. This Disclaimer message advises CDS users that the closed complaint information is not considered public information and that not all states actively and fully participate in providing information for this application. Click the OK button at the bottom of the Disclaimer information. (The disclaimer message will be asked every 365 days.)
5. The Closed Complaints Data Page will display. This page lists information about the entity and allows you to generate up to four different closed complaint reports. 

NOTE: The complaints date displayed next to the link will be the most current complaint closed date of the complaints associated with the identified entity.

Click the Report link to view the criteria available.

Four closed complaints reports are available:

Closed Complaint Counts by Code - displays the number of complaints selected for an entity based on various complaint codes (Type, Reason and Disposition) based on the criteria selected.

Closed Complaint Counts by State - displays the number of complaints for each state based on the criteria selected.

Closed Complaint Trend Report - displays the number and percent of change in closed complaints for an entity, based on the criteria selected. The information is displayed for the current year and the previous five years, as well as monthly detail for the past 36 months.  (NOTE: Selecting a specific time range criteria will not impact the results of this report.)

Closed Complaint Index - displays the market share (total business line premiums for the company in a specified state or zone/total business line premiums for all CDS companies in the specified state or zone) and complaint share (total CDS complaints for the company writing the designated line of business in a specified state or zone/total CDS complaints for all companies writing that line of business in the selected state or zone) for the selected company based on specific lines of business. An index of 1.0 indicates that the company had a percentage of complaints equal to its percentage of premium written for the coverage type and state(s) selected. The Index report is available only for those firms that have both closed consumer complaints and premiums reported through submission of their annual financial data to the NAIC. Current complaint year data is available on July 1st of the current year.

The CDS Complaint Index report provides the National Confirmed Complaint Median Index and National Complete Complaint Median Index values. These provide the median complaint index of all company indices obtained for the specified policy type for the specified calendar year.

The company's total complaints under the policy type for the calendar year are summed as "Total Complaints." NOTE: Total complaints includes both Confirmed and Unconfirmed complaints.

A Confirmed complaint is a complaint in which the state department of insurance determines:
a) The insurer, licensee, producer, or other regulated entity committed any violation of

1) an applicable state insurance law or regulation;
2) a federal requirement that the state department of insurance has the authority to enforce; or
3) the term/condition of an insurance policy or certificate; or

b) The complaint and entity’s response, considered together, indicate that the entity was in error.

Confirmed Complaints include those complaints in which one of the complaint resolution codes used by the state, also known as the “complaint disposition,” upheld the consumer’s complaint position. Complaint resolutions that uphold a consumer’s complaint position are as follows (implemented on 11/15/2010):

• Compromised Settlement/Resolution
• Claim Reopened
• Claim Settled
• Fine Assessed
• Referred for Disciplinary Action
• Company Position Overturned.
   

Unconfirmed Complaint Dispositions

• Company Position Substantiated
• No Action Requested/Required
• No Jurisdiction
• Referred to Another State's Department Insurance
• State Specific
• Refer to Outside Agency/Department
• Question of Fact/Contract Provision/Legal Issue
• Insufficient Information
• Complaint Withdrawn

The "Total complaints" value is the sum of all the closed consumer complaints submitted including all the complete and confirmed closed consumer complaints, that meet the search criteria.

The "Total Complaints" value is the count of the current year and the previous 5 years of data. The "Total Complaints" and "Selected Complaints" could be the same.

To refine the search parameters for the specific entity, complete the fields listed directly below the report links.  TIP: To view closed complaint information for a small number of states, click the "Remove All" button  to clear all selections, then select the state(s) by using the CTRL key and click the "Copy" button.

The following criteria can be specified for the Counts by Code, Counts by State, Counts by Trend, Index and Detailed reports:

State - the state from which a complaint was received

Zone - a geographical grouping of states from which a complaint was received

Open Date From - Specifies the date range when a complaint was opened (NOTE: Requires leading zeroes for days and months, as well as a four-digit year.)

Closed Date From - Specifies the date range when a complaint was closed (NOTE: Requires leading zeroes for days and months, as well as a four-digit year.)

Report Detail Level - Specifies how the report will display the list of complaints by either COCODE/Entity or group.

Complainant Type(s) - Specifies the identity of the complainant (Beneficiary, Insured, Producer, Third Party or Other, you may select individually by using the CTRL key or select all)

Role Code(s) - Specifies the identity of the entity being complained against. You may select individually by using the CTRL key or select all.

Medicare Supplement Policy(s) - specifies the Medicare Supplement policy type code (A through J and O and P). You may select individually by using the CTRL key or select all.

Insured Age Group - specifies the age range of the insured (All, Unknown, Under 25, 25 to 49, 50 to 64 and Over 65)

For the Index report the following must be specified. These criteria will modify only the Index report and have no effect on the other three reports. These criteria are located at the bottom of the Closed Complaint Index, and you may need to scroll down the page to view them. The Index report will calculate the report based on the following criteria, unless otherwise specified: Private Passenger Coverage Type, most current data year for the Premium Year and the most current data year for the Complaint Year. The following are possible criteria for the Index report.

Coverage Type - the type of coverage for which the index calculation will be based. Valid types are Private Passenger Auto, Homeowners, All Property, Individual Life, Group Life, Individual Accident and Health, Group Accident and Health, Credit, Long Term Care, and Medicare Supplement.

Premium Year - the year that the premiums for the index calculation will be based

Complaint Year - the year a complaint is closed by the state insurance department

Complaint Type - A user can select a report based on ALL Complaints or those considered "Confirmed".

1. To generate a report, click the Report link that appears below the selection criteria area.
2. To print a closed complaint report, select Print from the File menu. (NOTE: Closed complaint reports cannot be saved.)
3. To close the report page and return to the Closed Complaints data page, select Close from the File menu or click the close (X) button on the upper right corner of the page.
4. To perform another search or navigate to a different application within iSite+, select the appropriate link at the top of the Closed Complaints Data page.

Complaint Codes

This is a listing of all valid complaint codes by category. New complaint codes were implemented on November 15, 2010 for a mapping of codes go to Statenet or click the following link.

https://isiteplus.naic.org/cgi-bin/statenet/documents/market_regulation_mis_cds_code_changes_final.pdf

Type of Coverage

Type of Coverage codes indicate the type of insurance to which the complaint refers, such as Private Passenger Auto Liability coverage. These codes are provided by section (Auto, Homeowners, etc.) then by first level description (private passenger, commercial, etc.) and second level description (liability, physical damage, etc.)

Reason for Complaint

Reason for Complaint codes indicate the reason the complaint was filed. Reasons are indicated under the areas of Underwriting, Marketing and Sales, Claims Handling and Policyholder Service.

Disposition

Disposition codes indicate how the complaint was handled, such as Policy Issued or Restored.