The Office of General Counsel issued the following opinion on November 28, 2003 representing the position of the New York State Insurance Department.

Re: Complaint reporting requirements

Question Presented

Must an authorized life insurer log and report complaints to the Department that it receives from claimants¹ who do not submit their complaints to the Department?

Conclusion

No. Section 216.4(e) of Regulation 64, requires that "[a]s part of its complaint handling function, an insurer's consumer services department shall maintain an ongoing central log to register and monitor all complaint activity" concerning complaints submitted by claimants to the Department. There is no requirement that an insurer include in its ongoing central log maintained pursuant to Section 216.4, complaints from claimants who do not submit complaints to the Department. Additionally, Section 216.2 of Regulation 64 (Applicability) provides in part that Section 216.4 "shall not be applicable to policies of accident and health insurance written pursuant to the provisions of section 1113(a)(3) and the provisions of article 43 of the Insurance Law, where the claimant is neither a policyholder, a certificate holder under a policy of group insurance, nor a relative or member of the household of such policy or certificate holder."

Facts

The inquirer writes on behalf of an authorized life insurer's law department. The inquirer asks whether insurers are obligated to log and report complaints that they receive to the Department. The inquirer refers to insurers generally and provides no facts.

Analysis

Section 216.4(c) of Regulation 64 states in part: "Every insurer shall establish an internal department specifically designated to investigate and resolve complaints filed with the Insurance Department and to take action necessitated as a result of its complaint investigation findings." (Emphasis added) Section 216.4(e) states: "As part of its complaint handling function, an insurer's consumer services department shall maintain an ongoing central log to register and monitor all complaint activity." Thus, the ongoing central log required by Section 216.4(e) pertains to complaints submitted to the Department by claimants.

If an insurer subject to Section 216.4 of Regulation 64 receives an inquiry from the Department concerning a complaint filed with the Department, the insurer is required by Section 216.4(e) to include that complaint in its ongoing central log to register and monitor all complaint activity. There is no requirement that the insurer include in its ongoing central log maintained pursuant to Section 216.4 of Regulation 64 complaints from claimants who do not submit complaints to the Department. Additionally, note that Section 216.2 of Regulation 64 provides that the regulation is applicable to all insurers but that specified provisions are not applicable to certain types of policies as set forth by that provision.

For further information one may contact Senior Attorney Robert Freedman at the New York City Office.

¹  N.Y. Comp. Codes R. & Regs. tit. 11, § 216.1(b) (1982) (Regulation 64) defines claimant for the purpose of construction in Regulation 64 (Unfair Claims Settlement Practices and Claim Cost Control Measures) as "any person who attempts to obtain a benefit from an insurer."