Michigan Administrative Code › Department - Insurance and Financial Services › Insurance › Essential Insurance › Section R. 500.1508 - Complaint-resolution process; notice of rights; private informal managerial-level conference

Current through Vol. 24-12, July 15, 2024
Rule 8.
(1) At the
				time of a denial of automobile insurance or home insurance, the insurer or
				producer making the denial shall provide the person subject to the denial
				written notice of his or her right to submit a complaint and to have a private
				informal managerial-level conference if he or she has reason to believe that
				the denial is improper.
(2) If a
				person has reason to believe that he or she has been charged in incorrect
				premium and informs the insurer or producer of that belief, the insurer or
				producer shall promptly provide the person written notice of his or her right
				to submit a complaint and to have a private informal managerial-level
				conference.
(3) The written notices
				required under subrule (1) and (2) of this rule must be in language
				understandable to a person of ordinary intelligence and must include, but need
				not be limited to, an explanation of all of the following:
(a) The person's right to submit a complaint
				and the procedure the person shall follow if he or she wishes to submit a
				complaint.
(b) The person's right
				to be provided information pertinent to the denial or premium charge upon
				request, subject to payment of a reasonable copying charge. An insurer's
				reasonable copying charge under this subdivision must not exceed the rate
				charged for copying by the department in accordance with the freedom of
				information act, 1976 PA 442, MCL 15.231 to 15.246. The director shall inform
				insurers of that maximum allowable copying charge on an annual basis.
(c) The person's right to a private informal
				managerial-level conference addressing the complaint with the insurer, the
				procedure the person shall follow if he or she wishes to request a private
				informal managerial-level conference, and the process applicable to a private
				informal managerial-level conference. All of the following apply to that
				process:
(i) If a private informal
				managerial-level conference is requested, the conference and proposed
				resolution must be provided by the insurer within 30 days after the date of the
				person's request.
(ii) The private
				informal managerial-level conference may be held by telephone, video
				teleconference or other substantially similar electronic means, or in-person,
				as long as the following requirements are met:
(A) If the conference is held by telephone or
				video teleconference or other substantially similar electronic means, the
				insurer shall state at the beginning of the conference that it is a private
				informal managerial-level conference and identify all persons by name and title
				who are listening to, or otherwise participating in, the conference. In
				addition, the insurer shall either provide a toll-free telephone service or
				other service at no cost to the person making the complaint, or pay all charges
				associated with the conference. As applicable, the written notice must indicate
				the telephone number that must be called and state that the telephone number
				may be called collect if a toll-free number is not provided or explain in
				sufficient detail other instructions for participating in a conference held by
				video teleconference or other substantially similar electronic means.
(B) If the conference is held in-person, the
				conference must be held within a reasonably accessible distance from the
				Michigan residence of the person or persons named on the policy as insured or
				the location of the risk and be held at a time reasonably convenient to the
				person making the complaint or the person's designated
				representative.
(iii)
				The private informal managerial-level conference must include the participation
				of the person making the complaint, or the person's designated representative,
				and a supervisory or higher level representative of the insurer who is
				authorized to decide the dispute on behalf of the insurer.
(d) The person's right to submit a complaint
				to the director and for a review and determination if the private informal
				managerial-level conference fails to resolve the dispute. The written notice
				must explain this right as described in
				R
				500.1510.
(e) The person's right to appoint another
				person as his or her designee to act on his or her behalf throughout the
				complaint-resolution process set forth in this rule and
				R 500.1509 to
				R 500.1514.