DOI Complaints….
The subject of many blockbuster movies.
Well…
Maybe not.
However, if mishandled DOI Complaints can unfortunately result in regulatory investigations, fines, penalties, loss of regulator trust, reputational hazard, bad evidence, and loss of consumer trust.
DOI Complaints can be an opportunity to double check that the organization’s processes and actions are in line with the law. It can also be a time to shine in customer-centricity. If you want to stop reading, because I’m making a daunting process sound delightful please keep reading. This is intended to give some pointers to show compliance in responding to regulator complaints:
1) 📝 Details matter. If the Complaint notes Claim date of loss, Beneficiary information, Policy facts, and any of those points are incorrect make sure that the response corrects those points. It can be very easy to rush into the heart of the complaint and miss that the underwriting company noted is an affiliate, not the correct legal entity. Your response should include all accurate information.
2) 📬 Do respond. Not joking. There are some complaints that go unanswered. Strike that, there are some complaints that almost go unanswered for a long time. Maybe they go to an Inbox that is not monitored, or worse get put off. That said, a consequence of not responding to a complaint is not only a disgusted, disappointed, and probably more motivated complainant but also a regulator who has cause to levy an administrative penalty for not cooperating, or some other term in their Insurance Law.
3) 📚 Do your homework. Keeping in mind that a timely response is priority; balance the fact that the company and the regulator want an accurate and well-supported response. I strongly recommend seeking an extension if it is unlikely you can meet the DOI’s deadline. Remember, however, that some regulators are not keen on granting extensions consistently to the same company. The NAIC compiles data on companies’ complaints (topics, etc.). Complaint responses are important. By the way, if the Complaint doesn’t state a deadline, many states have this in Administrative Rule, or you can reach out to the regulator. For example, California’s deadline is 21 days. If you’re unsure if it’s calendar days or business days, verify and don’t wonder.
4) 📜 Document. Support your response. If there is policy language on which you are basing the claim denial, include this in the letter (and ensure that it’s the correct version of the policy). If the complaint alleges the company missed a statutorily mandated notice, and indeed your research finds that it was sent the response will be that much more credible if you show it.
5) ♬ Tone matters. Whether the complainant may be inflating some points in their version of events, or it appears that the complainant is lodging personal attacks against the company/ industry/ individual within the organization, remember that in difficult circumstances we have an opportunity to tell our story with compassion and dignity.
6) ✋ Trade Secrets Do Not Belong. When I was in banking, there was this saying I learned in Compliance School, “When in doubt, hand it out.” That advice does NOT apply here. Even if the answer to the question would be resolved by sharing a trade secret, consult with counsel prior to sharing what is not public information. Some DOIs share the company response with the complainant. Regardless, after the complaint investigation is closed, the complaint file is open for a Freedom of Information Act request.
To disclose or not disclose. Recall that I said that DOI Complaints are opportunities to confirm that processes are working. If you discover an error or it appears that this is a systemic issue, follow your organization’s process for internal investigation and disclosure.
7) 🤷♀️ Status Unknown. Once you respond, you may hear from the DOI on their conclusion. Or not. I do not have the split on states that give any status on closure of complaints. Know this, if the regulator determines the organization needs to fix something, you’ll hear from the regulator. The regulator may contact the organization through you, through leadership, through legal, through the market conduct area, … tomorrow, next week, or at an unknown date.
8) 🗄️ Maintain the file. Follow your company’s guidelines regarding maintenance and retention of the file and supporting documents.
Stay tuned for additional advice on responding to Direct Customer Complaints!
💡Quick heads up: I’m so glad you’ve visited the Compliance Corner. Everything I share is legal and regulatory, education and information. It’s not business, financial, or legal advice; it doesn’t create an attorney-client relationship between us. You should chat with an attorney in your area to make sure you’re protecting your business.
About Kay Godfredsen
Hello, my name is Kay Fairchild Godfredsen, a proactive, solutions-oriented, and pragmatic legal strategist with 20+ years of experience and demonstrated success in providing legal support to senior management and employees at all levels of the company on legal issues, risks, processes, policies, and procedures. As a seasoned legal strategist, I specialize in deciphering intricate legal puzzles and transforming them into actionable strategies. With a keen eye for detail, I dissect convoluted issues and provide comprehensive solutions that drive compliance, mitigate risk, and fuel growth. My legal acumen is seamlessly integrated with a deep understanding of the business landscape. I thrive on collaborating with cross-functional teams to align legal frameworks with corporate objectives. Together, we navigate the evolving regulatory landscape to foster innovation while ensuring airtight legal protection. Specialties: Strategic Legal Guidance, Crisis Management, Complex Corporate Transactions, Contract Development & Negotiations, Risk Assessment & Mitigation, Employee Performance Management, Data-Driven Decision Making, Cross-Functional Collaboration, Critical Situation Handling
Hello, my name is Kay Fairchild Godfredsen, a proactive, solutions-oriented, and pragmatic legal strategist with 20+ years of experience and demonstrated success in providing legal support to senior management and employees at all levels of the company on legal issues, risks, processes, policies, and procedures. As a seasoned legal strategist, I specialize in deciphering intricate legal puzzles and transforming them into actionable strategies. With a keen eye for detail, I dissect convoluted issues and provide comprehensive solutions that drive compliance, mitigate risk, and fuel growth.
My legal acumen is seamlessly integrated with a deep understanding of the business landscape. I thrive on collaborating with cross-functional teams to align legal frameworks with corporate objectives. Together, we navigate the evolving regulatory landscape to foster innovation while ensuring airtight legal protection.
Specialties: Strategic Legal Guidance, Crisis Management, Complex Corporate Transactions, Contract Development & Negotiations, Risk Assessment & Mitigation, Employee Performance Management, Data-Driven Decision Making, Cross-Functional Collaboration, Critical Situation Handling
