If you’re unhappy with your insurance company, you have options for making your voice heard and seeking a resolution. While there are many websites where consumers can post complaints and reviews, the most effective way to address issues is to file a formal complaint, typically through your state’s Department of Insurance. These departments possess the regulatory power to oversee insurance companies, investigate complaints, and, when necessary, enforce state laws.
Why File a Complaint?
The National Association of Insurance Commissioners (NAIC) identifies claim delays, unsatisfactory settlement offers, and claim denials as the top three reasons consumers complain about their insurance companies. Other common issues include disputes over how claims are handled, policy cancellations, non-renewals, and lack of response from the insurer. It’s important to understand the specific reasons for complaints, as this will help you present your case effectively.
6 Ways to File a Complaint
There are several approaches you can take to resolve an insurance dispute:
- Contact Your Insurance Agent: If you purchased your policy through an agent, they can act as an advocate on your behalf. As Corinne Kligmann of Lift Financial notes, “Their interests lie with yours, not with those of the insurance company. They can be a great ally and they are by far the easiest way to reach a good outcome.” If your agent cannot assist you, escalate the issue to their manager.
- Appeal to an Executive at the Insurance Company: Insurance companies have internal appeal processes. Before seeking outside assistance, make sure you have followed their established procedures. Some insurance companies do not readily make their appeal options known, so it’s wise to ask about it before going elsewhere. Check the company’s website for appeal options, and be aware of any deadlines for submitting an appeal.
- Complain to an Ombudsman: Some state insurance departments employ an ombudsman to assist in resolving complaints. This person acts as an advocate for consumers. If you’re not satisfied with your agent or the company manager’s solutions, contacting an ombudsman is a prudent next step to find a resolution. California and New Jersey are examples where the ombudsman are available to help.
- Take Your Complaint Public: While less direct, making your complaint public can sometimes get your insurance company’s attention. In fact, a public plea on social media could influence how the company handles problems, which could impact other potential consumers, according to Rick Sabo, an expert on insurance fraud.
- File a Complaint with State Regulators: State insurance departments are the official channels for filing complaints and are empowered to investigate suspected violations of state law. As Dennis Sawan, a personal injury lawyer, explains, the departments will investigate then allow the insurer to explain their position. The body then certifies either that no insurance law was broken, or if an insurance law was broken, will refer it to the market conduct division for enforcement.
- Take Your Complaint to Arbitration: Some policies may include an arbitration clause. Marc Fitapelli of MDF Law explains these clauses are increasingly in use. In arbitration, a neutral third party reviews the dispute and issues a decision. Binding arbitration requires you to accept the arbitrator’s decision, while non-binding enables a lawsuit if you disagree. However, if the policy is silent, the parties will have to litigate in court.
What to Include in Your Complaint
Each state’s Department of Insurance provides its own specific complaint form. A good starting point is the NAIC’s complaint page, which offers links to state department websites. When filing a complaint, be specific: provide your contact information, the exact name of the insurance company, your policy number, copies of your insurance card, and the name of any agent or adjuster involved. Also, include your claim number, date of the loss, a complete and concise explanation of your problem, and any supporting documentation, such as photos, invoices, emails, and a log of calls between you and your insurance company.
What Happens After Filing
If your complaint suggests a state law violation, the insurance department will likely send it to the insurance company for a response, review the response, conduct additional research, and possibly help you resolve the issue. They may also require the insurer to take corrective action if a violation is found. However, they cannot provide legal advice or become involved if there is current or pending litigation.
Expert Tips for a Successful Complaint
- Try to resolve the issue directly with the insurance company first. Michelle Megna, Insurance Lead Editor, suggests documenting contact with the insurance company, including dates, details, and who you spoke with.
- Provide comprehensive supporting documentation. Amy Danise, Insurance Managing Editor, recommends including all correspondence with the insurer.
- Expect to need patience. Jason Metz, Insurance Lead Editor, notes that the resolution process can take time. For example, in Indiana, the initial complaint is processed within 72 hours, with the insurer having 20 business days to respond.
