There are ways the state keeps insurers in check while assisting consumers

A lot of times I like to talk about how much money Department of Insurance employees save North Carolina residents. I’ve written before about how our Consumer Services Division helps consumers who have issues with insurance companies paying their claims or about how our Smart N.C. program provides patients who have been denied a medicine or procedure prescribed by their doctor get an independent review.

Our Seniors’ Health Insurance Information Program, which helps Medicare beneficiaries navigate their health insurance maze saves senior citizens millions of dollars. The Department’s Criminal Investigations Division investigates scams and fraud and returns millions of dollars in recoveries and restitutions following their investigations.

There’s another group of people at the Department of Insurance working hard to make sure insurance companies are doing what they’re supposed to do, pro- viding timely payments to consumers for their insurance claims while making sure they charge the correct premiums.

This group of people works for the Market Regulation Division. These employees mostly work behind the scenes. Consumers rarely, if ever, come in contact with our MRD employees. Their work can pay big dividends to insurance policyholders in North Carolina.

These employees routinely monitor the conduct of insurance companies in North Carolina, whether they’re property and casualty companies, such as homeowners’ and automobile insurance companies or companies that provide health or life insurance. They may examine health maintenance organizations, preferred provider organizations or premium finance companies.

Over the past five years, from 2020 to 2024, MRD employees’ examinations and market analyses resulted in nearly $24.7 million in refunds, including interest, to consumers. During that time, these employees imposed more than $1.8 million in regulatory fines, money that under the N.C. Constitution goes to the benefit of the public schools. Millions more in fines have been assessed this year.

The Department’s market conduct examiners will conduct general, target and compliance examinations:

· General examinations. Under state law, every insurance company has its records reviewed every five years to ensure the company is complying with insurance laws and regulations.

· Target examinations. Market regulators can initiate these investigations at any time and are often prompted by a trend of consumer complaints about an insurance company’s practices. · Compliance examinations. Whenever violations have been found, companies must provide a corrective action plan, and this includes ensuring that they have resolved the Department’s concerns.

Various divisions at the Department of Insurance work hard to protect consumers. I’m working hard and asking the Department’s employees to work hard, to make sure that North Carolinians are getting a fair deal for their insurance premium dollars.

N.C. Department of Insurance Commissioner Mike Causey.