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Answered 2017-01-01 23:12:54

If you're in the U.S., go to the state agency that regulates insurance companies. Each state has very specific laws and regulations.

All state insurance regulatory agencies have Consumer Services departments (although they may use different nomenclature). Their function is to be the gatekeeper for consumers and intercede on their behalf through investigation of complaints. Generally, you will need to complete a request for assistance (which in some states may be electronic), and specify the nature of your complaint. Be as specific as possible, including policy number, claim number, and of course the identity of the insurer; the complaint form may request that you submit a copy of your policy (never send your only copy).

Upon receipt of your material, the Consumer Services authority will request the insurer for its side of the story, and will attempt to facilitate a middle ground. Keep in mind that one side or the other is not always correct. Therefore, to better the chances that you will get the resolution that you seek, be sure to keep full documentation so that it is available for use in a dispute. Also remember to stay flexible, because it is usually the sign of a fair settlement when one side feels that they did not get quite enough and the other feels that they gave a little too much.

For those of you who want to do research on a company before you purchase a plan, many states will report the number of consumer complaints per company for their state. Many state insurance websites will report the numbers. Search using your state name plus "department of insurance."

As an agent, here is how I tell clients to interpret the complaint numbers. If a consumer reports a complaint to the state's insurance department it's probably a big complaint. Over a cup of coffee consumers may complain to each other about their insurance company, but when they report it to the state it's big. If you see a company with a large number of complaints, versus other companies, or greater than their share versus sales, I think there is good reason to possibly avoid the company. (Ratings, complaints, years in the business, history of rate increases, etc. are criteria used to compare companies).

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