“That’s not what they said!”
                  “Can they do that?”
                            “What does that mean? "
                                                     “My policy said that they should pay this!”

When dealing with insurance issues, consumers often have many unanswered questions.   Even after reading a policy or discussing a situation with a producer, a consumer may have many unanswered questions.  In some instances, consumers may ask themselves: Should I file a complaint?

Well, the Louisiana Department of Insurance (LDI) can help you. The LDI licenses and regulates insurance companies, producers, adjusters, and brokers to operate in this state. If you believe that one of these licensees hasn’t acted in accordance with your policy provisions and the insurance laws (regulations) of Louisiana, consider filing a complaint.

Since insurance language and state regulations may not be familiar to most of us, we often don’t know if we should file a complaint or handle our concerns as an inquiry. The National Association of Insurance Commissioners (NAIC) defines the terms as follows:

A complaint is any written communication that expresses dissatisfaction with a specific person or entity subject to regulation under the state’s insurance laws. An oral communication, which is subsequently converted to a written form, will meet the definition of a complaint for this purpose.

An inquiry is any oral or written communication that is not a complaint, such as a request for general information or an expression of an opinion regarding an insurance-related issue that may or may not require a response by the department of insurance.

• provide legal services that are sometimes needed to settle a complicated problem;
• dispute an underwriting decision made in accordance with an insurer’s underwriting guidelines;
• resolve a dispute that is a question of fact.

Once a complaint is filed, you will receive a case number. When contacting the LDI to check the status of your case, please refer to this number. The LDI representative will make every effort to promptly and thoroughly research your claim and work toward a fair resolution.

The major functions of the Office of Consumer Advocacy (OCA) are to act as a watchdog for consumers and ensure that consumers understand their rights as policyholders.  

The Office of Consumer Advocacy regularly takes part in various speaking engagements in and around the state of Louisiana to inform and educate Louisiana citizens about the regulations of the insurance industry. 

Since its creation in 2007, the OCA has had the opportunity to take part in numerous events. Presentations have been made at various organizations and locations such as Kiwanis and Rotary Clubs, neighborhood development foundations, Council on Aging Senior Centers and community meetings sponsored by LA representatives, senators and local councils.  The OCA has served as a guest class lecturer at various Louisiana universities, numerous churches and other civic organizations.  

The topics of interest are as follows: the role and function of each division within the Department of Insurance, the Policyholder Bill of Rights, the availability and affordability of insurance, catastrophe preparedness, the claims handling process, deductibles, rate increases, and hot topics such as tax incentives and mitigation discounts.

Understanding your insurance coverage can be a little intimidating sometimes.  Figuring out what coverage you need, how to balance premium costs, what you should do after a loss, and even what to do if you have a question or complaint, is often challenging.  These are some of the reasons the Office of Consumer Advocacy (OCA) created this newsletter.  OCA strives to be the source you can turn to for assistance; our goal is for this newsletter to provide helpful information to empower you when making your insurance decisions. 

This newsletter offers plain language explanations of insurance coverage, insight into how to handle the claims process and presents ways to help you save money on your insurance coverage.  Monthly outreach events are highlighted in the left banner section of the newsletter.  Many of these outreach events allow you to speak with an OCA staff member and get “one-on-one” assistance with your insurance needs. “Hot topics” will also be presented to inform you of changes in the industry and to keep you on the lookout for actions that you may have to take as a policyholder.

The OCA newsletter is e-blasted and posted on the Department of Insurance website the first Monday of each month.  Be on the lookout for the latest edition, and make sure to share it with your family and friends.

Deputy Commissioner
Clarissa A. Preston, CIC, APIR