Section 926.40  Complaint Handling Procedure

a)         Notification and Response Requirements

When a complaint is received by the Department of Insurance against an insurer, insurance producer, or other entity identified in Section 926.20 of this Part (respondent), the respondent shall be notified of the complaint.  The Department will, in its notification, specify the date when a report is to be received from the respondent which in most instances will be 21 calendar days after notification is sent to the respondent.

b)         Contents of Response or Report or Both

1)         Each respondent shall supply adequate documentation which explains all actions taken or not taken and which were the basis for the complaint;

2)         Documents necessary to support the respondent's position, or information requested by the Department, shall be furnished with the respondent's reply;

3)         The respondent's reply shall be in duplicate, but duplicate copies of supporting documents are not required;

4)         The respondent's reply shall include the name, telephone number and address of the individual assigned to the complaint;

5)         The Department will respect the confidentiality of medical reports and other documents which by law are confidential.  Any other information furnished by a respondent shall be marked "confidential" if the respondent does not wish it to be released to the complainant; and

6)         The complaint and all documents submitted with the complaint or in response to the complaint are deemed confidential and will not be released to third parties.

c)         Follow-up or Conclusion

Upon receipt of the respondent's report, the Department of Insurance insurance analyst will evaluate the material submitted and:

1)         Advise the complainant of the action taken and disposition of the complaint; or

2)         Pursue further investigation with the respondent or complainant; or

3)         Refer the complaint file to the appropriate Division within the Department of Insurance for further regulatory action.

(Source:  Amended at 23 Ill. Reg. 5695, effective May 3, 1999)