Filing a complaint with your state insurance department

When a complaint helps

A complaint works best when the problem is how the insurer handled the claim, because those are the rules a regulator enforces. Most state rules follow the NAIC's model, which sets deadlines and written-notice duties for insurers. Good reasons to complain include:

• Missed deadlines: no acknowledgment, no decision and no written reason for the delay.
• A denial without a reason: no written denial, or one that doesn't point to a policy provision.
• No answers: letters and calls ignored, or requests for an estimate or valuation report refused.
• Misstated policy terms or a settlement that seems to ignore your state's rule, such as taxes left out of a total loss.

Before you file, give the insurer one clear chance in writing: a dated letter that states the problem, cites the rule and asks for an answer by a set date. That letter often fixes the problem, and if it doesn't, it becomes the best exhibit in your complaint.

A complaint is weaker when the dispute is about facts or judgment, such as who caused the crash or what a repair should cost. The Texas Department of Insurance, for example, says it can't decide who was at fault in an accident and can't help with complaints about body shops.

Find the right department

Use the NAIC's directory of state insurance departments, or your state's page in claim rules by state, which names the department, its consumer phone line where one is published, and its complaint route.

• Usually the state where your policy was issued. Iowa's Insurance Division, for example, takes complaints only about policies issued or bought in Iowa.
• Claims against another driver's insurer are handled differently by different states. Texas says it can't help with complaints against another person's insurance company, so check your department's rules before you file.
• Online is usually fastest. Most departments take complaints online, and many also by mail or email.

What to put in a complaint

The person who reads your complaint knows nothing about your claim. Give them what they need to ask the insurer the right question:

1. The basics: your name and contact details, the insurer's name, the policy and claim numbers, the adjuster's name, and the date of the crash.
2. A short timeline: when you reported the claim, what you sent and when, and what the insurer said or didn't say, in date order.
3. The problem in one or two sentences: for example, no decision 60 days after proof of loss, or a denial that cites no policy provision.
4. What you want: a written decision, a written reason for the denial, a copy of the valuation report, or a second look at the offer.
5. Copies, not originals: letters and emails to and from the insurer, the denial letter, estimates and photos. TDI suggests pictures and letters to and from the company.

What happens after you file

1. The department reviews it and may ask you for more documents.
2. It sends the complaint to the insurer and asks for a response. In Texas, companies have 15 days to respond to TDI and can ask for a 10-day extension.
3. It reviews the insurer's answer against the law and the policy, and tells you the result.
4. The insurer may change its decision, pay part of the claim, or explain its position in more detail.

The complaint also goes into the insurer's record with the regulator. Some departments publish complaint data; Texas lets you see whether a company has complaints. A pattern of violations can lead to enforcement action against the insurer, but that is separate from your own claim.

What a department can and can't do

TDI puts the limit plainly: it can't make a company pay a claim unless not paying violates a law or the terms of your policy. When the dispute is about the amount of a covered loss, appraisal may fit better; see the appraisal clause.

In a few states the department is also a required first step for a legal claim. In Maryland, a lawsuit over an insurer's failure to act in good faith on a first-party property and casualty claim generally has to start as a complaint to the Maryland Insurance Administration, which decides within 90 days (Insurance Article §27-1001). See insurance bad faith.

Questions people ask