Date: 11/26/2024

The Oregon Division of Financial Regulation (DFR), through its consumer advocates, recovered nearly $1.6 million for Oregonians in the third quarter of 2024.

DFR’s consumer advocates field calls every day from concerned and confused Oregonians over insurance and financial issues from institutions that are regulated by the division. Advocates have extensive industry knowledge and they analyze complex issues.

In the third quarter of this year, advocates have helped recover $1,599,299. The first two quarters of 2024 saw $5,397,613 in recoveries, bringing the year-to-date total to nearly $7 million.

“This is money that goes directly back into the pockets of Oregonians,” said Andrew R. Stolfi, Oregon insurance commissioner and director of the Oregon Department of Consumer and Business Services. “Consumers don’t have to work alone in trying to fix an error by an insurance company or financial institution. Our consumer advocates are here to help.”

Here are a few examples of work DFR advocates did during the third quarter:

A consumer filed a complaint as they were being charged for a hernia repaired while they were under anesthesia for another surgery. Upon receipt of the complaint, it was found that during the provider appeal, an agent accidentally denied the claim in error as the consumer’s responsibility, resulting in an amount due for the consumer. The claim was then denied correctly as “provider responsibility” for not getting the appropriate authorization for a hernia that would heal on its own. This kept the consumer from being balance billed for $15,830.38.

A consumer purchased travel insurance and suffered a medical event during the trip. A claim was filed, and the consumer provided the medical bills to the company and was reimbursed $453.80, which was the maximum coverage limit. The consumer then submitted additional bills that went above the maximum coverage limit, but the insurer did not communicate either acceptance or denial for about 11 months. The consumer submitted a complaint and the insurer acknowledged that there had been delays in communication, but there would be no further payments made as the maximum coverage limit was previously met. After a division consumer advocate had further discussion with the insurer, the company agreed to issue an additional $173.80 to satisfy the consumer’s expenses

A consumer submitted a duplicate payment through a money transmitter, and the company returned the duplicate payment to that money transmitter. However, the consumer did not receive the payment from the money transmitter. After the division’s involvement, the consumer was refunded $1,068.65.

“Our consumer advocates are highly skilled professionals dedicated to solving consumer challenges,” said DFR Administrator TK Keen. “Their expertise and commitment ensure that consumers get the help they need, resulting in meaningful recoveries throughout the state.”

Anyone who may need a consumer advocate can call 1-888-877-4894 (toll-free) or email dfr.insurancehelp@dcbs.oregon.gov for insurance questions and dfr.financialserviceshelp@dcbs.oregon.gov for financial services questions.

Source: Division of Financial Regulation 

https://dfr.oregon.gov/news/news2024/Pages/20241126-dfr-recovers-millions-for-oregonians.aspx