Company complaint outcome (disposition) descriptions

The outcome (disposition) of complaint describes the resolution of the complaint by our office. A single complaint may have up to 3 outcomes.

Updated 02/2011

Outcome (disposition)

Company Position Overturned: Complaint resolved by a regulated entity or individual to ensure compliance with applicable state law/requirement, via additional payment, restored benefit or policy status, and/or other means. Insurance Department found the regulated entity or individual to be in violation or otherwise at fault.

Complaint Withdrawn: Complainant requested that the complaint be withdrawn.

Compromise Settlement / Resolution: Complaint resolved voluntarily by a regulated entity or individual, via additional payment, restored benefit or policy status, and/or other means. No finding by the Insurance Department that the regulated entity or individual was in violation or otherwise at fault.

Claim Reopened: Regulated entity or individual has reopened claim for further investigation or settlement
negotiation. A final resolution of the claim has not been determined.

Claim Settled: Claim brought to conclusion, in whole or in part, and no other disposition is appropriate.

No Action Requested / Required: Department of Insurance received only a copy of a complaint that the complainant sent directly to the company, or there was no direct request for assistance.

Referred to Another State's Department of Insurance: Complaint falls under the regulatory jurisdiction of another state's insurance department.

Referred to Outside Agency / Department: Complaint referred to other state agency/department.

Fine Assessed: Insurance Department assessed monetary penalty against the regulated entity or individual.

Referred to Other Division for Possible Disciplinary Action: Complaint referred elsewhere within Insurance Department (Legal, Agent Services, Investigations, etc.) based on apparent or suspected violations of state law, etc.

Question of Fact / Contract Provision / Legal Issue: Complaint involves a question of fact, or a question of law involving a contract provision or interpretation thereof, and therefore falls outside the regulatory authority of the Insurance Department.

Company Position Substantiated: The regulated entity or individual upheld its original position, and appears to be in compliance with applicable statutes/regulations.

No Jurisdiction: Complaint does not fall under the regulatory authority of the state's Insurance Department, and was not referred to any outside agency, Department or court system.
Includes Action Suspended for litigation and/or formal arbitration.

Insufficient Information: Complainant failed to provide sufficient information/documentation to warrant further
investigation.

State Specific: Insurance Department will use a further state-specific code to track data needed for a
purpose not shared by other states or the NAIC.

 


See also