North Carolina was battered by Hurricane Florence last year and reports show very concerning issues of claims handling and low claim payments after the storm. Perhaps Hurricane Michael losses pulled adjusters out of North Carolina and for some insureds caused additional delays to their claims. North Carolina does have an option where you can advise the North Carolina Department of Insurance the details of your claim, but the system is not very user friendly—even the person answering the phone advised that the online version is hard to find on the website.
Nevertheless, North Carolina policyholders should let the Department of Insurance know the details of their claims when they encounter issues, and the online form is a simple process.
Here is the mission statement of the North Carolina Department of Insurance:
The North Carolina Department of Insurance aims to respond promptly, clearly and courteously to consumers’ insurance-related questions and complaints, assist consumers in resolving those complaints whenever possible, and help consumers understand their options for dealing with insurance-related matters.
Here is what the North Carolina Department of Insurance explains it can do to help:
WE CAN…
1. Forward a copy of your complaint to your insurance company, and require the company to provide a response/explanation.
2. Review the company’s response for compliance with applicable North Carolina statutes, regulations, and policy requirements.
3. Require the company to take corrective action if we determine that the company’s position does not comply with applicable requirements.
4. Help you understand your insurance policy.
5. Recommend courses of action that you can take to resolve your problem, if we do not have the regulatory authority to resolve it ourselves.
6. 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.
WE CANNOT…
1. Act as your legal representative in or out of court.
2. Intervene in a pending lawsuit, on your behalf.
3. Consult with you if you are represented by an attorney, unless we have your attorney’s written permission.
4. Regarding a dispute between you and your insurance company, establish:
a. Who was negligent or at fault.
b. The value of a claim or the amount of money owed to you.
c. The facts surrounding the claim (that is, who is being truthful when there are differing accounts of what happened).
d. The facts regarding any other disagreement between you and another party.
5. Address plans or companies that are not subject to the insurance laws of North Carolina, or that are governed by other state agencies (see “Health Plans that We Do Not Regulate”, below).
o Health Plans that We Do Not Regulate
The North Carolina Department of Insurance pledges to seek fair treatment of all parties in insurance transactions. We are here to serve you.
If you would rather, you can call the North Carolina Department of Insurance consumer helpline too free at 855-408-1212 or print and mail in the complaint form.
As always, if you are uncertain of your insurance claim rights or if you have questions about your policy benefits, please do not hesitate to contact the attorneys at Merlin Law Group.
