WHO WE ARE​

HOW WE HELP CONSUMERS 

The MIA provides assistance to consumers, businesses, health care providers (including doctors and hospitals), and producers (agents or brokers) in all areas of insurance, including life, health, disability, automobile, homeowners, and property. T​​​he MIA produces consumer guides, rate comparisons and frequently asked questions related to various types of insurance. ​

INVESTIGATION OF COMPLAINTS 

The MIA can educate you about your rights and investigate written allegations that your insurance carrier, insurance producer (agent or broker), or another entity (engaged in the business of insurance) has violated state law. Violations may include: 

• Denying authorization for medically necessary services.
• Improperly denying or delaying payment of all or portions of a claim.
• Improperly terminating your insurance policy.
• Raising your insurance premiums without the  proper notice or in excess of what the law  allows.
• Making false statements to you in connec​tion with the sale of insurance or the processing of insurance claims.
• Overcharging you for services, including premium finance charges. 

THIS IS WHAT WE CAN DO 

• Forward a copy of your complaint to the insurer, if appropriate 
• Obtain information or explanation​s on your behalf from the insurer or their representatives. This may involve written and verbal contact with such companies or persons 
• Review in detail the information obtained from the insurer for compliance with statutes, regulations  and policy contracts
• Provide general information about the provisions of your insurance policy, as appropriate
• Share general tips that could aid in resolving your insurance problem
• If it is determined that the actions of an insurer, insurance producer or other regulated person are in violation of a statute or regulation that the MIA enforces, the MIA may take corrective action against that company or person

THIS IS WHAT WE CANNOT DO

• Act as your legal representative, in or out of court.
• Intervene in a pending lawsuit on your behalf.
• In the case of disability insurance complaints, make a medical decision as to the extent of an individual’s disability. The MIA investigates complaints involving disability insurance to determine:
1. whether or not the denial decision is arbitrary or capricious; and 
2. whether or not the denial decision was rendered in accordance with the terms of the insurance contract and State insurance laws and regulations.
• Address complaints or inquiries involving insurance contracts that are not subject to the jurisdiction of the insurance laws of the state or matters governed by other state or federal agencies. Generally, this includes, but is not limited to:
• Self-funded or self-insured plans; 
• Medical Assistance (Medicaid) except for prompt pay; 
• Medicare and Medicare HMOs; 
• Federal Employee Health Benefit Programs; 
• Uniform Services Family Health Plans; 
• Workers’ Compensation; 

• or Contracts issued and delivered to the policyholder in another state. For more information about the Maryland Insurance Administration’s jurisdiction, click here.
  

• Ask the Maryland Moto​r Vehicle Administration (MVA) to “hold” a fine pending the investigation of your complaint. 
• In the case of a property or casualty claim (an automobile, homeowners, renters or business claim), while the MIA can determine if an insurer has violated Maryland law or its actions were reasonable based on the information available at the time of the action or decision, the MIA generally cannot make determinations about:
• who is liable in a tort or contract legal action, 
• who was at fault;
• which witnesses are credible and which ones are not; 
• or the value of a claim as long as the insurer’s decision is reasonable.​

TO FILE A COMPLAINT 

RAPID RESPONSE PROGRAM 

HEALTH COVERAGE ASSISTANCE TEAM (H-CAT)