SALEM — A year ago, when an electrical fire burned their Prineville home past the point of repair, Jim and Tiffany Fewell’s insurance company offered them $65,000.

Saying that was not enough to rebuild the couple’s home, they argued with the company for months. Under stress, they fought with each other, too. Tiffany, who worked for Les Schwab Tire Centers in Bend, was pregnant. Contemplating a future where the family nest egg had largely disappeared, “it seemed like I was crying all the time,” she said.

Then the couple complained to the state, and got the attention of Tracie Weeder, a consumer advocate for the Oregon Insurance Division. Following Weeder’s intervention, the insurance company ended up forking over $140,000 — enough, with a lot of free labor from family and friends, to build a new 1,300-square-foot home and cover the cost of the Fewells’ rent for the past year.

Weeder is part of a small, low-profile unit of the Oregon Insurance Division that helps consumers do everything from understand their policy to get their calls returned by their insurance company. And with Oregonians suffering one of the highest unemployment rates in the nation, the unit this year is seeing a significant boost in calls from consumers: 15 percent over the year before, many of them coming from people hard-hit by the economy.

On average, the consumer advocacy team gets a call every 15 minutes during business hours. Many of them come in through the unit’s toll-free number, 888-877-4894.

And yet the complaints reported to the state are likely only a fraction of the ones consumers have in Oregon, said the team’s manager, Ron Frederickson. “It’s one of our biggest challenges: A lot of people don’t even know we exist.”

These days, the calls often come from people wondering how to get health insurance now that they’ve lost their job, or how they will be able to afford a recent rate hike.

“We do a lot of education,” Weeder said.

The eight advocates also look into complaints, whether taken over the phone, in the mail or through the agency’s Web site. They often explore further, with potentially lucrative results: In 2008, according to the division, they caused insurance companies to reconsider decisions, and fork over $2 million to policyholders that otherwise likely would not have been paid.

The team does not have the authority to force insurance companies to do anything; rather, its members serve as intermediaries or liaisons in disputes between a consumer and the company. Because advocates’ power is limited, Frederickson said, consumers often come away dissatisfied.

In the Fewells’ case, however, Weeder confirmed the couple’s claim that they signed up for full coverage for their house, which cost more than $200,000. She kept asking the company questions. Forced to answer those questions, the company eventually had to admit the couple was right.

“It seemed like she basically had to pull teeth to get anything out of them,” Tiffany Fewell said. “(Weeder) told them flat out, ‘this is the law, and you need to follow up with me.’”

Sometimes one complaint leads to others. Advocates share information with the enforcement arm of the division, which has the power to essentially rifle through insurance company claim files and see if there is a pattern of improper denials of benefits or other illegal behavior.

Because a single complaint can be the first evidence of a pattern of wrongdoing, the consumer unit essentially acts as the agency’s “radar,” Frederickson said. “We’re going to see what’s going on out there before anyone else.”

Agency officials cite plenty of examples, such as:

•Three years ago, the agency started getting complaints concerning senior citizens who had been sold life insurance, including some who were mentally incompetent. The policies often tied up all or most of the seniors’ money, leaving them unable to pay other expenses.

The complaints led to an investigation, and the firm, Bankers Life and Casualty Co., paid a $150,000 fine and refunded the money of about 20 seniors who were sold inappropriate policies.

•Last year, a complaint from a woman whose medical claims were denied by Pacificare Life Assurance Co. led to the discovery that the firm had been improperly denying claims without checking to see if the claims were covered. Of 10,000 claims from Oregonians that were denied in a 21-month period, 5,000 turned out to have been denied improperly.

Industry representatives say the unit is effective without being unfair.

Lana Butterfield, a lobbyist for American Family Insurance and an insurance agents group, said, “I think they’ve made an effort to reach out to consumer groups and to try to put some things that are helpful up on their Web sites. … Agents appreciate that, too.”

Kenton Brine, the Northwest regional manager for the Property Casualty Insurers Association of America, agreed, but said he is concerned that some of the educational materials released by the unit can be misleading.

For instance, the unit posts on its Web site an annual report showing the number of complaints received about a company as compared with its share of the Oregon market in premium dollars.

In the state’s rating system, State Farm scores well, while Allstate and Geico do not. Frederickson considers the report’s ratings a good indicator of what sort of service a consumer can expect from a given company.

Brine disagrees, saying that the rating penalizes firms that do not specialize in low-risk clients. More high-risk clients means more claims, which likely means more complaints, he said. He said that just because a company gets a subpar rating from the state does not mean a prospective customer should expect a bad experience with the company.

Tiffany Fewell, for her part, isn’t concerned about that. She’s just glad someone told her husband about the consumer unit so he could file a complaint online.

Thirteen months after the fire threw their life into disarray, the couple moves into their home next month. Tiffany said it’s all thanks to Weeder.

“They wouldn’t have done anything if it had just been us talking, because we don’t know the law,” she said. “The only reason we got as far as we did was because of her.”

Getting help

With the recession, state consumer advocates are seeing a significant rise in calls from consumers seeking help.

• For consumer tips and Oregon Insurance Division contact information, see Page A6.

Seeking help?

In the wake of the recession, state consumer advocates are seeing more calls from consumers seeking help. Tips from the Oregon Insurance Division’s consumer advocacy unit:

• Don’t wait for a collection notice before paying your auto insurance. Unlike health insurance policies, auto insurance policies do not allow a 10-day grace period before your policy can be canceled if you miss a payment. Most companies require payments to be received by — not just sent by — the due date. If you can’t afford your coverage, ask your insurer about ways to cut your bill.

• Know what you’re buying. If you’re tempted by that low-cost health coverage, consumer advocates warn that high-deductible or limited-benefit insurance plans could leave you holding the bag if you ever run into a real health problem. And medical discount cards are no substitute for a real health plan.

• Get informed. The Oregon Insurance Division Web site, insurance.oregon.gov, offers a plethora of advice and resources. And the consumer advocacy unit can be reached toll-free Mondays through Fridays at 888-877-4894.

Source: Oregon Insurance Division