In a perfect world, all insurance claims would be handled promptly and to your complete satisfaction. Then again, in a perfect world, you wouldn’t need insurance. Alas, perfection continues to elude us and our insurance carriers. The National Association of Insurance Commissioners (NAIC), which keeps track of complaints filed with the various states’ insurance divisions, had already recorded close to 2,000 complaints by the end of January 2011 (the total for 2010 was 77,784). As in 2010, the top three issues to date are Delay in Claims Handling, Denial of Claims and Unsatisfactory Settlements or Offers. Accident and Health Insurance, Automobile Insurance and Homeowners Insurance continue to receive the most complaints, as they have since 2008. Here’s what you need to know if you want to file an insurance complaint.
Assuming you’ve already attempted to negotiate with your insurance carrier and still aren’t satisfied, you’re next step is to contact your state’s insurance commissioner. The NAIC has a list of current websites for all 50 states. Every state has different regulations regarding insurance and different procedures for filing a complaint. Most include a form you can download.
Understand going in that filing an insurance complaint with your state will not be a slam dunk process. You can help speed things along by filling in the form as completely and accurately as possible. Confine your comments to just the facts, listed in chronological order (include the actual dates, if you remember them), and leave your personal feelings out of it.
Include photocopies of any relevant documents and correspondence such as letters and emails to and from your insurance company, as well as notes from any phone conversations. In the case of notes, be sure you include the name and title of the person you talked with along with the date and time of the conversation. Word to the wise: Never, ever send the originals. Keep those for your files.
To avoid unnecessary delays and further frustration, double check the address to be sure you’re sending your complaint to the right division. Large states, like California for example, assign complaints to different units within the division. You’ll want to include that info in your address. If you’re not sure where to send your complaint, go back to the website for your state’s insurance commission phone number and call.
You should receive a letter confirming receipt of your complaint within a month or so. If you haven’t heard anything back, follow-up with a phone call. Once you have the receipt, continue to check the progress of your claim every few weeks. With bureaucracies, squeaky wheels do get the grease.
Note that certain types of complaints like those about workers compensation, HMOS and prepaid health plans may not fall under your state’s insurance commission’s jurisdiction. Check your state’s website to learn what types of complaints they can and can’t handle.