Skip Ribbon Commands
Skip to main content
Navigate Up
Sign In
Home > Complaint Stats-2014-CDI

Complaints Reviewed in 2014 by the California Department of Insurance

The California Department of Insurance is one of the state regulators that oversees Californians' health care coverage. 

The following table outlines information the department reported to OPA about the health care complaint cases it reviewed in 2014.

California Department of Insurance - 2014 Statistics
Most Common Reasons for Complaints Reviewed in 2014
  • Claim denial (24%)
  • Unsatisfactory settlement offer (11%)
  • Medical necessity denial (7%)
  • Out-of-network benefits issue (6%)
  • Cancellation (6%)
  • Premium notice/billing issue (5%)
  • Co-pay, deductible, and co-insurance issue (5%)
  • Experimental (4%)
  • Claim delay (4%)
  • Unsatisfactory refund of premium (3%)
Most Common Results from this Department's Complaint Review in 2014  
  • Health plan position substantiated (27%)
  • Question of fact/contract/law falls outside regulator (20%)
  • Consumer's money returned (17%)
  • Health plan in compliance (7%)
  • Advised complainant (7%)
  • Claim settled (3%)
  • Additional payment (3%)
  • Compromise settlement/resolution (2%)
  • Other results (14%)
Number of Days a Complaint Review Took in 2014 Between 21-157 days


  • The time frame noted above includes time for regulatory review after the case is closed to the consumer who filed the complaint. CDI indicated that this final regulatory review period is 30 days on average.

 

​ ​​​​​​