How To File a Complaint Against an Insurance Company

Insurance is supposed to protect you when life takes an unexpected turn. Whether it’s a car accident, healthcare emergency, or damage to your home, you rely on your insurance company to honor your insurance policy and pay valid claims. 

State insurance laws require insurers to honor policy terms and follow fair claims practices. As you’re likely aware, that’s not always the case. When your insurance company treats you unfairly or fails to follow insurance laws, it’s important to understand your right to file a consumer complaint. 

In this article, we discuss the circumstances under which you might file an insurance complaint. We’ll also review the processes involved, how to get started, and what you can do if the matter remains unresolved.

Filing a complaint can be an easy and free way to resolve an issue. The remedies for doing so, however, are limited. In some cases, you may want to consult a consumer protection or insurance attorney before you file a complaint. They can help you understand the bigger picture, including possible outcomes from the complaint process and how to preserve your claims for potential legal action later.

In the meantime, let’s review some of the reasons people may have a beef with an insurer or another entity regulated by insurance laws.

Common Grounds for Filing an Insurance Complaint

Consumers may file insurance complaints for many reasons. A complaint may pertain to any type of insurance policy. It might be against your own insurer, another insurance company, or other insurance industry players, like pharmacy benefit managers or public adjusters.

Common examples across various policies include:

• Health insurance: Denial of coverage for necessary medical treatment or unfair limits on health plans
• Life insurance: Delays in paying benefits under a life insurance policy or disputes over an annuity
• Homeowners and renters insurance: Low payouts after a fire/storm or refusal to cover valid claims
• Workers’ compensation insurance: Employers or insurers refusing to pay benefits after a workplace injury
• Long-term care insurance: Rising premiums or denial of coverage for nursing home stays

These complaints can relate to misconduct, such as if an insurer mishandles your claim or violates the terms of your insurance policy. A complaint can also allege insurance fraud if it involves intentional deception, like misclassifying medical treatments to deny coverage for valid insurance claims.

Where Do You File Your Complaint?

When you have an insurance complaint, knowing where to turn is key. In some cases, you may want to attempt resolution of the problem with the insurer directly. More often than not, however, you may lack trust in their ability to be impartial at this point. Accordingly, you might want to start the complaint process with your dedicated state agency.

Every state has a department of insurance responsible for enforcing state insurance laws and protecting consumers. An insurance commissioner typically runs this department, which handles most insurance complaints and can investigate your case. In some states, a separate agency handles workers’ compensation disputes.

You’ll find your state’s insurance department through its official website. Most have a .gov website where you can file an online complaint form. Many also offer a toll-free phone number for help.

How To File Your Complaint

The specific complaint process you must follow can vary by state. In general, following these steps will help you experience a smooth complaint process. 

Step 1: Gather Supporting Documents

You’ll want to collect any relevant documentation. This often includes: 

• Your insurance policy
• Claim forms and correspondence
• Letters from the insurance company
• Photos or other evidence
• Medical records 

Make sure to keep detailed records of calls with your insurer.

Step 2: Complete the Complaint Form

Most state insurance departments have an online complaint form on their website. You can also call their toll-free number to file by phone. In whatever manner you file, you should be prepared to provide:

• Your contact information
• Insurance company name, policy number, and claim number
• Names of insurance agents, adjusters, and other involved representatives 
• Clear description of the problem
• Copies of supporting documents

You will likely also have to state your desired outcome. In doing so, keep in mind that the department’s power is limited to enforcing insurance laws through corrective action. Even though consumers may also be entitled to compensation from the insurer, the state insurance department cannot award it. Only a court can.

Step 3: Wait 

After you submit your complaint, the state insurance department will review it and the accompanying materials. Often, it will:

• Contact the insurer
• Conduct an investigation as it finds appropriate
• Compare the insurer’s actions against insurance laws/insurance policy terms

As part of its investigation, the department may also interview you. If it ultimately finds misconduct, it may:

• Order the insurer to honor a claim or refund premiums
• Reverse wrongful denials/correct claim handling
• Penalize insurers for violations, including fines or license suspension

The department will typically notify you of the outcome with additional information about next steps. The entire process can take weeks, months, or even longer for complex cases.

What if the Complaint Process Falls Short?

Sometimes, filing with the state insurance department isn’t enough. It can’t award you compensation beyond claim payments, but a court can. This is common when a matter involves:

• Bad faith conduct: Deliberate dishonesty or unfair claim handling by the insurer
• Emotional distress/pain and suffering: Harm beyond the financial loss itself
• Additional financial harm: Losses caused by the wrongful denial or delay

These additional losses resulting from the insurer’s misconduct could lead to compensation for lost wages, medical debt, or rental costs. In addition to these consequential damages, a court may award punitive damages for bad faith conduct and fraud.

It’s difficult to determine how to proceed without knowing whether you might be able to recover additional compensation. For this reason, many insurance attorneys offer free consultations during which they’ll likely review the relevant policy and provide you with a case evaluation.

Speak With a Lawyer

If you consult a qualified lawyer before you begin the complaint process, they can help you avoid common pitfalls that could hurt your case or your ability to negotiate later. They may even recommend skipping the complaint step entirely. After all, it could be a waste of time to pursue a regulatory process that cannot award compensation beyond claim payments.

A skilled lawyer who specializes in consumer protection or bad faith insurance can help you preserve your rights to legal action. It’s important to note, however, that a lawsuit is seldom the first step. In fact, some policies require arbitration or mediation before you can sue, particularly in health or auto disputes.

Even if yours doesn’t, an attorney well-versed in the tactics used by insurers may be able to negotiate a settlement on your behalf. This could involve communications, including a demand letter, with compelling legal arguments and supporting evidence. This usually signals to the insurer that you are serious, know the compensation to which you’re entitled, and won’t hesitate to pursue legal action. 

Finding an Insurance Attorney

Each matter is unique, and insurance laws can be highly state-specific and rather complex. Thankfully, you don’t have to figure out your next steps without the benefit of legal guidance. A skilled insurance lawyer can help you understand the full range of options available to you. 

You’ll want to meet with an advisor licensed in your state who has plenty of experience dealing with insurance companies. They should also have a solid track record of proven results.

Finding the right attorney is a difficult starting point for many outside the legal profession. To help, FindLaw has compiled and made publicly available its dedicated directory of consumer protection attorneys and insurance lawyers. You can review ratings and background information for experts in your area and see which ones offer free consultations.

Plan to meet with an attorney sooner rather than later. That way, you can begin to make informed decisions as you move forward.