California insurance success stories

Amidst the challenges posed by the complex insurance landscape in California, there have been notable instances of success and positive outcomes that highlight the resilience and adaptability of both insurers and policyholders. Here are a few California insurance success stories:

1.   Innovative Wildfire Coverage Solutions:   Some insurance companies in California have been proactive in offering innovative wildfire coverage solutions. These include policies that provide coverage for fire-related damages and expenses, even in high-risk areas. These solutions have offered peace of mind to homeowners who might otherwise face difficulty in obtaining affordable and comprehensive coverage.

2.   Community Collaborations:   Certain communities and neighborhoods have come together to form self-insured groups or co-ops. These collaborations enable residents to pool resources and collectively negotiate insurance coverage, leading to more competitive rates and tailored solutions that address their specific needs.

3.   State-Backed Insurance Initiatives:   The State of California has taken steps to address the insurance challenges faced by homeowners in high-risk areas. The creation of the California FAIR Plan (Fair Access to Insurance Requirements) has provided an option for those who have difficulty obtaining traditional coverage. This state-backed plan offers essential coverage as a safety net.

4.   Advancements in Risk Assessment:   Some insurance companies in California have embraced advanced technologies such as AI, satellite imagery, and data analytics to better assess risks. This has enabled more accurate underwriting and pricing, ensuring that homeowners receive fair and accurate coverage.

5.   Mitigation and Resilience Efforts:   Both insurers and homeowners have increasingly focused on implementing mitigation and resilience measures to reduce the impact of potential disasters. From upgrading homes with fire-resistant materials to creating defensible spaces, these efforts have led to improved property protection and, in some cases, lower insurance premiums.

6.   Education and Outreach:   Non-profit organizations, government agencies, and insurance companies have collaborated to provide educational resources and outreach programs to homeowners. These initiatives empower individuals to make informed decisions about their insurance coverage and take proactive steps to protect their properties.

7.   Local Disaster Preparedness Initiatives:   Some local governments and communities have launched initiatives focused on disaster preparedness. By raising awareness and promoting emergency planning, these efforts contribute to reducing the severity of losses and strengthening community resilience.

8.   Alternative Risk Financing:   Some businesses in California have explored alternative risk financing options, such as captive insurance companies. These entities allow businesses to customize their insurance coverage and risk management strategies to align with their specific needs and risk profiles.

These success stories illustrate the capacity for innovation, collaboration, and adaptation within the California insurance landscape. While challenges remain, these examples demonstrate that positive outcomes can be achieved through strategic planning, community engagement, and a proactive approach to risk management.

WILDFIRES

Just got the best news! My insurer is going to pay out 100% of the personal property claim without a content list!

For me, it was excruciating to try to work on this list because my mother died in the fire. To try and list all her belongings and when/where/how much it all cost (when I have no idea), it was brutal. The loss of my mother has been devastating. To try and do this inventory too, it was just too much to ask.

…I was so relieved, I started to cry. My deep gratitude goes out to the commissioner and your office. Really, you saved me from this awful, traumatic task… it’s an added relief not to have to worry about the depreciation and actual value – since I would not be replacing anything. I hope the insurance companies waive the inventory list for the folks southern CA too.

Thank you!

– Jessica T. (Facebook comment left on February 18, 2018)

HOMEOWNERS INSURANCE

Dear Insurance Commissioner,

On April 13, 2017, my insurer sent me an unexpected check as a refund on my homeowner’s insurance for my policy issued between December 9, 2016-February 13, 2017, “as a result of pending litigation with the California Department of Insurance.”

Wow!

Thank you for your hard work! Much appreciated!

– Donna H., Santa Cruz, CA

HEALTH INSURANCE

As a patient with severe obstructive sleep apnea, and a history of heart failure, I had learned the value of communicating early and often with my medical providers.  When I noticed my sleep quality degrading, despite being a compliant CPAP user, I contacted my primary care physician. My doctor ordered what I had always known as a basic test, namely, an in-lab sleep study to evaluate the issue and to understand what pressure the doctor would order the machine to be set to.  

When my insurance company denied my test as “not medically necessary” I was certain that it was just a misunderstanding, lack of documentation, or some other administrative issue that would be corrected. When my doctor’s office tried to resolve this and no progress was made, I began to get concerned. My concern turned to disgust as I quickly realized that my insurance company was denying coverage despite the fact I clearly met their parameters and requirements for the test.

I was truly facing a large, unorganized, machine of an insurance company that I felt did not value my health, my policy, or the fact that my hard work pays for the policy that was issued. They denied my doctors legitimate order for testing repeatedly, and processed my appeals without any genuine concern for my health and welfare. Unlike the Department of Insurance, when my insurance company “reviewed’ my case data, they did not even look at all of the available healthcare records that were in their possession. It was clear that my insurance company was hopelessly lost in understanding me as a patient and rather only saw me as a liability.

The Independent Medical Review (IMR) process was an amazing act of professionalism in my experience. Submitting the case for review was straightforward, and the Department of Insurance communicated with me about the status of my review in a very timely fashion. I was able to submit supporting documentation, as was My insurance company, who submitted their own policies and procedures as well as their various denials. The Department of Insurance had an appropriate resource trained in the area of medicine that was at issue in my case review the relevant documents. When I read the summary from the reviewer, I felt an enormous burden lift, because I realized that finally somebody was listening who was clearly motivated by a positive health care outcome.

The decision to direct my insurer to provide the coverage I was entitled has directly led to me being able to be successfully treated. To me, this means quality of life, and the ability to work so that I can provide for my family. My insurance company was shortsighted and treated me like a number. The Department of Insurance treated me like a human, with dignity, and has empowered me to restore my health!

My wife and children would like to thank everyone at the California Department of Insurance. Obviously for me, being healthy is important. My family means everything to me, and if my insurance company had their way, I am not sure I would be in the best place to take care of them.

Thank you does not convey it well enough. 

– Tony S.
(Email received February 3, 2014)

https://www.insurance.ca.gov/0400-news/0105-success-stories/