The Consumer Service Section is available to assist all West Virginia consumers, insurance companies, and their agents with insurance questions or complaints. The employees of the Section work hard to provide the highest level of consumer awareness and protection for those individuals experiencing insurance related problems. They concentrate on mitigating current and future problems by informing and educating the public as to their rights and responsibilities under individual insurance contracts and the laws of West Virginia.
The Section acts as a liaison between the insurance consumers of West Virginia and the insurance industry, working to help resolve disputes. The Section actively monitors industry compliance and is often the first line of defense for identifying potential problems within the industry or a particular company. The Section receives Inquiries and Complaints through telephone inquiries, walk in visits, and written correspondence. Examples of the types of inquiries processed by this office include:
• Laws and Regulations
• Contract Provisions
• A.M. Best rating
• Company Addresses and Telephone Information
♦ Communication (Breakdown between parties)
♦ Misrepresentation (Agents/Consumers)
♦ Claims (Settlement Offers/Denials)
♦ Contractual Provisions (Exclusions/Non-covered Benefits)
♦ Statutory Violations (Non-renewals/Cancellations)
The Section performs an evaluation of each formal complaint by obtaining documentation, reviewing the facts, determining fulfillment of contractual obligations, and identifying if any statutory violations have occurred. The Complaints Examiner then recommends the proper resolution that is in compliance with the laws and regulations of the State of West Virginia.
Some resolutions result in the refunding of premiums, the restoration of a cancelled contract, claims payments being made, or a contract being rescinded. The Section works closely with both the consumers and the industry so that an equitable resolution can be achieved. If deemed appropriate the examiner may refer a case to the agency’s Legal Section for further investigation.
In addition to the inquiries that the Section directly receives, the employees go offsite to conduct seminars for various groups throughout the State. The purpose of these seminars is to educate and assist individuals on insurance matters. The Consumer Service Section is often the “face” of the agency and continuously strives to provide the highest quality service to our agency’s customers.