If you file a claim with your insurance company that is denied, or run into problems with your policy that are not being resolved satisfactorily, you have the option of filing a complaint with your state's Department of Insurance. Before you do so, make sure that you have made an effort to resolve the matter on your own, and then provide the insurance department with copies of all available documentation so that they can fully investigate your complaint. Filing a complaint is a last resort, and should only be done after you have exhausted your other options.
Before You File the Complaint
Contact your insurance agent or the customer service department and discuss your problem. If you are unable to achieve results by talking with them, you should draft a letter and send it to the insurance company. Many times, providing your complaints to the company in writing will initiate an internal investigation that resolves the issues.
Make sure that you have provided all of the information the insurance company may request from you. It is not unusual for a claim to be held up because of incomplete information that the claimant has provided. In this situation, the denial is not absolute, merely a delay while the necessary information is being gathered. Once you have given them what they need from you, the claim will be processed normally.
Find out from the insurance company why the claim is being denied. If possible negotiate with the company to resolve the issues. It is very important that you have tried to get the situation cleared up yourself before approaching the department of insurance, and failure to do so could result in the insurance department ignoring the complaint, or worse, siding with the decision of the insurance company.
How to File
Many insurance departments allow you to file a complaint online, and have the necessary forms available to simplify the process. If not, you can request a complaint form from the department website and have it mailed to your address.
Describe your situation and the nature of the complaint completely. This provides the insurance department with information about your policy, the problem you are having, and which insurance company is involved. Include details about what has transpired in your dealing with the insurance company, including the names and contact information of anyone you have talked with at the company regarding your claim. Be sure to include information about the policy itself, such as the type of policy and the relationship you have with the person who was insured.
Explain what you have done to try and resolve the problem yourself, and what the effects of your efforts have been. Include a detailed request of how you would like to have the problem resolved, and include copies of any correspondence you have received in relation to the claim. Do not send original copies to the insurance company, but send copies of everything you have that is related to the case. The better you are able to express your side of the case, the better your chances of having the situation resolved satisfactorily.