File a Complaint With Your State Insurance Commissioner

Insurance Claim Problems? Possible Insurance Fraud? Know Your Rights

An upset business woman sitting at a table in her restaurant learns that her business interruption loss is not covered by her policy from her insurance agent
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When you run into trouble with your insurance, it can be a frustrating experience. Fortunately, some people can help you resolve your issues. Insurance is a regulated industry, and each state has its own State Insurance Commissioner to address issues within the state. The State Insurance Commissioner is there to help you when you are worried that you are being treated unfairly or need help.

How to Get Help With Your Insurance

Although the State Insurance Commissioner can help you, you may also be able to get help from:

  • Your claims adjuster, or their manager
  • Your agent or broker, and their manager
  • The Insurance Company Ombudsman

Before turning to your State Insurance Commissioner, be sure to try reaching out to the people above first to make sure your situation can not get resolved at the base level first. All of the above people are supposed to help you when you run into problems, and they should be in a position to explain how things work and work toward a fair resolution.

The reason that you want to reach out to them first—and try and speak to supervisors if necessary—before going to the commissioner is that this might save you time and additional work.

If you feel like no one is listening, if you think something is very wrong and that the people you have already talked to can not help you, then you are not out of luck because you do have the option to contact your state insurance commissioner and get them involved to help you.

Who Is the State Insurance Commissioner?

The State Insurance Commissioner is different in every state. State Insurance Commissioners are public officials who regulate the insurance industry in their state. If there is an injustice in the insurance industry, they can investigate and help a consumer to make sure the laws are being respected, and things are being done fairly.

How Can the State Insurance Commissioner Help?

State insurance commissioners resolve thousands of complaints every year, many of them involving issues such as:

  • Disputes with insurance companies
  • How one's insurance claim was handled
  • Problems with the sale and service of an insurance policy

Making a Complaint

Before you buy insurance online or even consider getting an insurance quote, it is always best to know your rights as a consumer. If you ever find that you need to file an insurance complaint with your state insurance commissioner, there are a few things you will want to do or be prepared to do. First, go to your state insurance commissioner's web site and find out what the process is to file a complaint. Many state insurance commissioners will have a complaint form available to download or fill out online.

Filling in a Complaint With the State Insurance Commissioner

Once you know how to start the process, you will want to compile every piece of documentation that pertains to the complaint and start keeping records of all phone conversations and agent contacts. Insurance companies often have large insurance claims departments and service call centers. You may end up speaking to a new person each time you contact the claims department, so you need to keep your records of all conversations with the insurance company. Once you have your documents together—and know how to file the complaint—it is time to submit it with your state's insurance commissioner officially.

What to Expect When You File a Complaint

Now that the complaint is filed, your state insurance commissioner's office will likely contact you asking for any additional documentation they will need. In most cases, the next step the commissioner will take is to send a copy of the complaint to the insurance company and give them a designated response time. Most likely, if the commissioner feels the response is adequate, they will send you a copy of the explanatory letter.

However, if the commissioner feels the company's response is inadequate, your case will probably be taken over by a state-designated representative. This person will work with you and the company to resolve the issue and ensure the laws, contract terms, and state regulations were followed in the process.

One important thing to remember in the complaint process is that even if your case is assigned a state-designated representative to try to resolve the situation, that person cannot act as your attorney. Due to the complaint and your confidence in dealing with the insurance company, consider hiring an attorney to represent you.

Article Sources

  1. National Association of Insurance Commissioners. “About the NAIC.” Accessed Aug. 1, 2020.