In the aftermath of the devastation left by Hurricane Helene, many have seen heart-wrenching scenes on TV, social media or other online sites of families frustrated by institutions that are supposed to be in place to help them. These include consumers who don’t believe they’ve gotten an appropriate response from their insurance company.
If anyone is having an issue with a claim, whether it’s related to Hurricane Helene in Western North Carolina or if it’s just trying to understand your insurance policy, you can get help from our Consumer Services Division.
We have full-time consumer specialists answering phone calls and monitoring complaints received online to get North Carolinians answers about their policies and claims. Often, we can help expedite claims payments and cut through red tape.
You can call our toll-free line at 855-408-1212 between 8 a.m. and 5 p.m. Monday through Friday. Or you can go to www.ncdoi.gov to file your complaint.
Here are some of the things we can do for you. We can:
Forward a copy of your complaint to your insurance company and require the company to provide a response/explanation.
Review the company’s response for compliance with applicable North Carolina statutes, regulations, and policy requirements.
Require the company to take corrective action if we determine that the company’s position does not comply with applicable requirements.
Help you understand your insurance policy.
Recommend courses of action that you can take to resolve your problem if we do not have the regulatory authority to resolve it ourselves.
If your situation involves a health plan’s noncertification decision (denial based on lack of medical necessity), refer you to the Department of Insurance’s Healthcare Review Program (HCR Program), for further guidance.
Then there are some things we’re unable to do. We cannot:
Act as your legal representative in or out of court.
Intervene in a pending lawsuit, on your behalf.
Consult with you if you are represented by an attorney unless we have your attorney’s written permission.
Regarding a dispute between you and your insurance company, establish:
Who was negligent or at fault.
The value of a claim or the amount of money owed to you.
The facts surrounding the claim (that is, who is being truthful when there are differing accounts of what happened).
The facts regarding any other disagreement between you and another party.
Address plans or companies that are not subject to the insurance laws of North Carolina, or that are governed by other state agencies.
Last year, our Consumer Services Division helped put $83 million back into the pockets of North Carolinians. This includes $70.5 million in life insurance payments by using a tool designed to locate lost life insurance policies and $12.4 million after consumers filed complaints regarding their insurance companies.
Insurance can be complicated. You don’t have to deal with your insurance company alone.
