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
•••

Comstock Images / Stockbyte / GettyImages

When you run into trouble with your insurance, it can be a frustrating task to manage. Whether there is a dispute over the value of a claim, a severe delay, an error, or some other issue, it can be daunting to try to resolve it all on your own. Fortunately, there are systems in place to correct such problems, and many sources you can reach out to for help. The insurance industry is highly regulated and each state has its own rules. At the highest level, the State Insurance Commissioner is in charge of holding people to these rules. The main duty of this role is to make it easy for people to get help when they suspect they are being treated in an unfair manner.

If you need to resolve a problem with your insurance company, there are many ways to do so. Here we'll cover your options, as well as how to go about filing a complaint at the highest level.

What Should I Do if I Have a Problem With My Insurance?

Although the State Insurance Commissioner can help you, there are many other people you may also be able to get help from first. These include:

  • Your claims adjuster
  • Your agent, broker, or others at their firm
  • The insurance ombudsman

Before turning to your State Insurance Commissioner, you should first try reaching out to the people above to see if your problem can get fixed in a more simple fashion at the base level. (If any of them give you trouble, you can go up the ladder to their supervisors as well.) All of the above people can explain how things work behind the scenes. They know how insurers must act to adhere to the law and can spot any issues that you might miss. They can also clear up any points that may be confusing or unclear. The professionals may also be able to help all parties work to solve the problems in a fair manner, or at the very least, direct you to sources that can.

The main reason to reach out to agents or other people at the ground level before going straight to the state commissioner is to save time. If you can resolve the problem close to the source, you can avoid a lot of extra work.

If you feel like no one is listening, or if you think something is very wrong and that the people you have talked to so far cannot help, don't despair; you are not yet out of luck. You still have recourse at this point, because you have the option of filing a report higher up and getting the state insurance commissioner involved to help you.

Who Is the State Insurance Commissioner?

State Insurance Commissioners are public officials in charge of regulating the insurance industry in their state. This includes making sure the markets are fair, as well as guarding consumer rights. If there is an injustice in the insurance industry that affects you, they can help you make sure the laws are being respected, and enforce the laws so that things are being done fairly. They can also assign agents to probe the issues and conduct investigations if it seems one is needed.

State insurance commissioners resolve thousands of complaints each year. Some of the most common issues they hear include:

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

How Do I Make a Formal Complaint?

Before you buy insurance online, and even before you start to gather quotes, it is always best to know your rights as a consumer. If you can prepare ahead of time, you may be able to tackle any issues as they come up. But if you're far into the process and learning the ropes as you go, you may need outside help.

If you ever find that you need to file a formal complaint with your state commissioner, there are a few things you will want to prepare for. Before taking any other steps, go to your state insurance commissioner's website and find out what the process is to file a complaint. Read each step and all the fine print. Look for deadlines, guidance, and look at sample forms if they have them. Many state insurance commissioners will have a complaint form that you can download and send in, or fill out online.

What Do I Need to Get Started?

Once you know how to start the process, go back and compile every piece of information that pertains to the complaint. If you haven't been doing so, start keeping records of all phone conversations and agent contacts. Insurance companies often have very large claims departments and service call centers. You may end up speaking to a new agent each time you call, so you need to keep your records of each person you talk to with the insurance company. Make notes of time, date, and what you talked about. Once you compile all your documents and know the process for filing with your state office, it is time to submit the complaint.

What Can I Expect After I File a Complaint?

Once the complaint is filed, your state insurance commissioner's office may contact you asking for any other forms or 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 deadline to submit their response. The company will reply with details of their side in a letter, citing any actions on your end to defend their stance as well. If the commissioner feels the response is valid, they will send you a copy of the letter.

If the commissioner feels the company's response is flawed or somehow wrong, your case will be taken to the next level. At this point, you may be handed over to a representative that the state will assign to your case. This person will work with you and the company to research the claim and resolve the issue. They are looking for whether the state laws and terms of the contract were followed in the process, starting from day one. They will also look for any foul play or suspect actions.

It will be up to you to decide whether to hire an attorney as your case moves forward. Think about the complaint, the amount of money or other value at stake, and whether you trust all parties involved.

One important thing to note in the complaint process is that even if your case is assigned to a state-designated representative to try to resolve the issue, that person is neutral. They are not acting on your behalf.