Insurance Complaints – Tips on How to File One

April 19, 2023

Insurance complaints that are filed with your state’s department of insurance can be an effective method for resolving an issue or problem with an insurance company. You have a right to file a complaint against an insurance company, an insurance agent, or a specific claims adjuster.

Every state has a department of insurance and a website that handles insurance complaints. Complaints may involve a coverage issue, claim dispute, unfair claims handling, premium issue, sales misrepresentations, etc.

Prior to filing a complaint, it’s recommended that you first try to contact the insurance company to resolve the issue. Send a written request to the manager outlining the problem and ask if they could reconsider their position on the matter. Let them know that you will be moving forward with a formal insurance department complaint if you don’t get resolution quickly.

If they stand firm on their position, then move forward with a complaint.

Tips on How to File Insurance Complaints:

• Perform an internet search for the applicable insurance department complaint form in your state. For example, search for North Carolina department of insurance complaint form
• Most states will let you file your complaint online using their online complaint form
• Provide contact information such as your name, phone number, email, insurance company and policy or claim number
• Briefly describe the issue and explain your position
• List important dates such as when you submitted documentation, when you called or emailed, when they responded or failed to respond to your communications
• Attach copies of your applicable documents, emails, and letters that you sent or received
• State what you think the insurance company should do to resolve the problem

Once your complaint is filed, the department of insurance will open an investigation and notify the insurance company of the complaint. The insurance company is required to respond to the complaint within a designated period of time.

After the insurance company responds, the department of insurance will investigate and determine if the company handled your issue appropriately, within the terms of the policy, and in accordance with applicable insurance laws. If any state insurance laws were broken or policies violated, the insurance department may take enforcement actions. In addition, the insurance department may send you a copy of the insurance companies response to your complaint.

What Actions and Results Can You Expect from an Insurance Complaint?

• Insurance department will forward your complaint to the insurance company and require the company to provide a response/explanation
• Insurance department will investigate your complaint
• They will help you understand the issue or policy questions
• They will help you get a clear response to your problem
• They will review the company’s response for compliance with applicable law and policy requirements
• Recommend courses of action you can take to resolve your problem

The department of insurance can’t require an insurer to pay your claim and they can’t resolve a dispute that is a question of fact. However, filing a complaint can result in a desired outcome for several reasons.

Normally, a manager at the insurance company will be required to review your issue and respond to your complaint. This is a second set of eyes reviewing your problem and that could get you better results. Also, if the manager determines that your complaint has merit, they will look to correct the problem and may change their original stance and position.

From start to finish, most complaints are resolved within 30 to 45 days. If the insurance company isn’t handling your diminished value claim in good faith, filing an insurance department complaint can be an effective tool during the negotiation.

To learn more about diminished value claims and how to file a complaint, please contact us for a free claim review. DVCHECK can be reached at (850) 201-1950.