Friday, November 04, 2005

Battling Cylons: Coda

Well, I received an email today from the Department of Insurance. It included the official reply from VID regarding my client’s recent “troubles.”
In their official reply, VID’s “Regulatory Advocate” restates the situation as it developed, and neatly inserts a CYA clause: “There is no indication that [VID] received this request on [stipulated date].” In other words, even though they’ve acknowledged that they erred in not processing the change which started the whole mess, and in fact acknowledged that error in writing, they apparently did so even though there was no indication that they were, in fact, at fault. And notice the weasel wording “there is no indication;” they don’t explicitly deny having received the change request, only that we offered no proof that they had. Of course, I don’t recall ever being asked for any such proof.
It does, however, get even better, because according to the Regulatory Advocate, once he reviewed the situation (nine days after it was submitted to VID by the Department of Insurance), he decided that my client was right, after all, and notified the appropriate department to reinstate Oriental Hut’s coverage because “the amount due to be reimbursed was more than the amount due for the October premiums.” Nice, and it only took him an extra 9 days to determine this.
But it gets even better.
Imagine his surprise when he learned that, shortly before he (allegedly) called for reinstatement, my client had indeed called in the payment, thus obviating the need for this Regulatory Advocate to have done anything in the first place. If you find this all confusing, you’re not alone. I’m also a bit flummoxed by the idea that a carrier can make a mistake and yet my client faces potential financial ruin, and there’s precious little that can be done about it. In reading the final report, I also noticed something else that was missing:
A simple apology.
As it is, I answered the DOI’s email, thanking the Claims Specialist for her help, and posing two additional questions:
It appears that not only did [VID] err in how they applied the credits, but that [my client] actually owed no premium for October, yet was cancelled anyway. Apparently, [VID] will face no consequences for this. Is that correct?
It also appears that [VID]'s procedure for reinstatement looks a lot like extortion: "we made a mistake, but you must follow our rules in resolving it, meantime you have no coverage." Is this acceptable insofar as the DOI is concerned?
In her response, the Claims Specialist explained that her role is “to make the consumer "whole", if there is a violation of our insurance statutes or the insured's contract. As an administrative agency, our legal authority is limited to ensuring that [the] insurance company abide by the consumer's insurance contract with them, and with our Ohio insurance statutes.
Which is a roundabout way of saying “hey, it’s in the contract, and they haven’t actually killed anyone, so deal with it.”
She then deftly sidestepped the whole issue by explaining that “(o)ur Market Conduct Division tracks repeated "errors" or statue violations.” Ahah! It’s someone else’s problem! Good to know that.
If you detect a drop of bitterness in this post, it’s because the underlying issue – company makes a mistake, insured pays the price – has not been addressed, or resolved.
Maybe next time…
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