How to File a Complaint with Your State Department of Insurance

Your state’s Department of Insurance (DOI) is a resource for information on insurance companies’ financial stability, but it also regulates insurance companies’ handling of claims for promptness, fairness in negotiations and good faith settlements. Simply put, you, as a consumer, have a right to file a complaint with them if you believe your insurance claim has been mishandled or you haven’t gotten a reasonable, timely settlement. Another option is to contact an attorney who specializes in insurance bad faith. The attorney is working for you and your best interest and will be quicker and much more aggressive than the DOI.

Complaints and the DOI

Every state has a DOI, known by different names around the country. In California, for example, it is the Department of Insurance, but in Massachusetts, it is the Division of Insurance and in Michigan, it’s the Office of Financial and Insurance Services. Each state has a website for its insurance department (see Resources below for a link that will lead you to your local DOI). Most of the websites allow you to easily file your complaint online.

Individual complaints are typically made for such things as improper denial or delay in the settlement of a claim, illegal cancellation or termination of an insurance policy, misrepresentation by an agent or broker, and problems regarding insurance premiums and rates. If your complaint is regarding the handling of a claim, it is possible that the insurance company may be guilty of dealing in bad faith. This means that they have treated you unfairly either in the process of investigating your claim, denying coverage for it, or settling it.

Ask yourself the following questions if you are considering filing a complaint with the DOI:

• What would you like to see happen and will you get the satisfaction you want from filing this complaint?
• Will the insurance company be penalized in any way for their actions or inactions?
• Will you get quick results?
• Alternatively, would it be wiser to hire a lawyer who specializes in bad faith insurance matters?

Filing a Complaint vs. Hiring an Insurance Attorney

When you file a claim, the DOI will ask for all of your documentation and then begin an investigation of the matter along with the thousands of others they handle every day. It may take a long time until they determine what the outcome should be, and that outcome may or may not be what you had in mind. More often than not, the matter will go to mediation and a mediator will attempt to bring the parties together to resolve the issues.

An attorney who specializes in insurance bad faith, on the other hand, will be quicker and much more aggressive than the DOI. The attorney is working for you and your best interest. While no attorney can guarantee any particular outcome, he knows what your goal is because he will thoroughly discuss the issues with you, and can then advise you on what strategy will help you to reach it. To your attorney, you are a real person with a real problem that needs resolution. To the DOI, you are just another complaint form.

Should you do both, that is, hire an attorney and file a complaint with the DOI? Most DOIs will tell you that if you have an attorney representing you or you have a lawsuit pending against the insurer, their ability to mediate your claim is limited, and they will often wait until your litigation is resolved before doing any investigation to look into insurance regulations that were not followed by your insurer. At that point, such an investigation may still be appropriate because some government regulations may not have been addressed in the litigation. It is not a bad idea to cover all your bases by doing both.

Resources

For a no-cost, no-obligation evaluation of your case, fill out our free case evaluation form and an experienced attorney will review your complaint. Our Insurance Advice site has links for all state departments of insurance.

For more information about bad faith insurance practices and claims, see the following articles:

Insurance Claims: Typical Bad Faith Insurance Lawsuits and Awards

Insurance Claims: How an Insurance Bad Faith Attorney Can Help

Don’t Be Afraid of the Big, Bad Insurance Company!

Case Studies: Filing Complaints With State Departments of Insurance

Case Study 1: Improper Denial of Insurance Claim

John Smith filed a claim with his insurance company after his house was damaged in a storm. However, the insurance company denied his claim, stating that the damage was not covered under his policy.

Feeling that his claim was mishandled, John decided to file a complaint with the Department of Insurance in his state.

Case Study 2: Illegal Cancellation of Insurance Policy

Mary Johnson received a notice from her insurance company stating that her auto insurance policy was being canceled due to a recent traffic violation.

However, Mary believed that the cancellation was unjustified and that the insurance company was in violation of the law. She decided to file a complaint with the Division of Insurance in her state.

Case Study 3: Misrepresentation by Insurance Agent

Sarah Davis purchased a life insurance policy based on the advice of an insurance agent who promised her certain benefits and coverage.

However, when Sarah needed to make a claim, she discovered that the policy did not provide the coverage she was led to believe. Feeling deceived, Sarah decided to file a complaint with the Office of Financial and Insurance Services in her state.

Case Study 4: Delay in Settlement of Insurance Claim

Mark Thompson filed a claim with his insurance company after his car was involved in an accident. However, weeks went by without any progress on his claim, and Mark felt frustrated by the delay.

He decided to file a complaint with the Department of Insurance to address the insurer’s handling of his claim.