Dealing with an auto insurance claim can be a frustrating experience, especially when you feel your carrier or the at-fault party’s insurer is being unfair, slow, or is outright denying a valid claim.
When direct negotiation with the insurance company fails, your next powerful step is to file a formal complaint with your state’s Department of Insurance (DOI), often called the Office of the Insurance Commissioner.
The DOI is the government agency responsible for regulating insurance companies and ensuring they adhere to state laws and the terms of their policies. While the DOI cannot act as your lawyer or award you a settlement, they can investigate violations and compel the company to comply with the law, which is often enough to break a logjam in your claim.
Here is a step-by-step guide to filing an effective complaint.
Step 1: Attempt to Resolve the Issue Directly
Before escalating to the DOI, you must first give your insurance company a fair chance to resolve the issue. The DOI will ask if you have done this, and your efforts strengthen your complaint.
- Go Up the Chain: Speak to the claim adjuster’s supervisor or manager. Clearly explain your issue, cite the section of your policy you believe supports your position, and ask for a specific resolution.
- Document Everything: This is your most crucial task. Keep a detailed log of every interaction:
- Date and time of every call or email.
- The name and title of the person you spoke with.
- A concise summary of the conversation and any agreements made.
- Send Written Confirmation: After a phone conversation, immediately send an email or letter confirming what was discussed.
Step 2: Locate Your State’s Department of Insurance (DOI)
The exact name of the department varies by state (e.g., Division of Insurance, Department of Financial Services), but you can easily find it.
- Google Search: Search for “[Your State] Department of Insurance Consumer Complaint.”
- NAIC Tool: Use the National Association of Insurance Commissioners (NAIC) website, which provides a directory and links to every state’s insurance department.
You will typically be directed to an Online Consumer Complaint Form or a printable PDF.
Step 3: Gather All Necessary Documents
The clearer and more complete your submission, the faster the DOI can act. Do NOT send originals; send copies of everything.
- Personal and Policy Information:
- Your full contact information.
- The exact name of the insurance company and agent (if applicable).
- Your policy number and claim number.
- The date of loss (accident date).
- Correspondence:
- Copies of all relevant emails, letters, and faxes between you and the company.
- Your detailed log of phone calls (from Step 1).
- Claim Documentation:
- Police report.
- Initial repair estimates or the total loss valuation report.
- Any other supporting documents (e.g., medical bills, appraisal reports).
Step 4: Write a Clear and Concise Summary
Most complaint forms have a dedicated box for the “Details of Complaint.” Treat this like a formal business letter:
- Start with the Facts: State clearly what happened and when.
- Detail the Problem: Explain why you are filing the complaint. Common issues include:
- Unreasonable delay in the claim process.
- Improper denial of a claim.
- Unsatisfactory settlement offer (lowballing your car’s value).
- Failure to communicate or respond.
- State the Desired Outcome: Tell the DOI exactly what you want the insurance company to do (e.g., “I want the company to issue a fair settlement check based on a correct ACV of $12,000,” or “I want the company to respond to my demand letter within 10 business days.”).
Important Note: The DOI is an investigator, not a judge. They cannot provide legal advice, intervene if you have an attorney, or determine who was at fault in an accident. They focus on whether the insurer violated state law or your policy terms.
Step 5: Submit the Complaint and Wait for Confirmation
- Submit: File the complaint online or mail/fax the completed form and supporting documents to the DOI.
- Acknowledgment: The DOI will typically send you an acknowledgment letter or email with a Case Number and the name of the analyst assigned to your case. This may take up to a week.
- Investigation: The DOI will officially notify the insurance company, provide them with a copy of your complaint, and require a detailed, written response within a set period (often 10–20 business days).
This simple act of filing can often spur the insurance company into action, as they take official government inquiries very seriously.
