According to the State Departments of Insurance, consumers complain most about their claim settlements. Sometimes the insurer is at fault, but sometimes policyholders are responsible for not receiving the correct coverage.
Today I will walk you through how to file an insurance claim complaint. The process will be used in Georgia, my home state. You can find the process in your state on the website of any state’s Department of Insurance. You can also call your Department of Insurance to get more information.
If you are unable to resolve the dispute with your company, you can file a complaint with Department of Insurance. Even if your appraisal process has not been completed (found in your policy), you can still file a complaint with the Department of Insurance.
The Department of Insurance’s Consumer Services Division provides information to consumers and investigates complaints against producers and companies. They deal with most insurance issues, including home, auto, car, health, HMOs, credit, and dental. These problems can include coverage issues and claims disputes, premium problems or sales misrepresentations. They also handle policy cancellations and refunds. A complaint against a Public Adjuster will be investigated by them.
The Consumer Services Division won’t:
Offer legal advice and act as your attorney.
Recommend an agent, insurance company or policy.
You can resolve a dispute if the only evidence you have is your word against that of the adjuster or producer, or the company.
They will make decisions based on the facts of a case. They will not determine who is at fault for an accident, or the value of stolen or damaged property.
If the complaint involves the insurance company, they can resolve the matter. They could, for example, resolve complaints against restoration contractors that you were required to use by your insurance company.
Take medical decisions.
The Department of Insurance recommends the following:
Carefully read your policy. Before you have a loss, it is important to understand what your policy covers. Your Agent can provide an explanation if you have any questions about the coverages that you have purchased.
Keep a copy of any correspondence between you, the insurance company. Keep track of all communications with your insurance company. This includes the number of calls, the date and hour of each call, and the name and title (if applicable) of the person you spoke to. Keep track of what was discussed after the call.
Ask the company to provide details about the language in your policy that pertains to your claim. The disagreement could be because the insurance company and you interpret your policy differently. You can file a complaint with the Consumer Services Division and provide the documentation that will contain the policy language in dispute.
Take photos or videos of the contents of your home if you can. This will be helpful in case of loss. The pictures and videos should be kept safe in a safe place or another location.
REMOVE AUTO AND HOMEOWNER CLAIMS
All receipts for any repairs made to your property following damage should be kept. You may be required to make repairs that are reasonable and necessary to protect your property. These repairs are covered by your policy.
The claims adjuster should inspect the property. Before making any permanent repairs, make sure to take photographs or videos. Do not make permanent repairs until an adjuster has examined the damage.
Ask the adjuster to give you an itemized explanation about the settlement offer. This should include depreciation and sales tax for homeowners claims. Holdback depreciation is required for policies that cover replacement costs. The amount of money that is withheld from your claim settlement until the repairs or replacements are complete is called holdback depreciation.
Ask the adjuster how he arrived at the estimated amount. If there are disagreements about the settlement offer, be prepared to discuss your claim. It will be easier to get documentation on the items you own.
Contact your insurance company first if you have a dispute about a claim.
Make sure to have your policy number handy when you contact your insurance company. Inquire about the address where you should send your written dispute. Describe your complaint and the way you expect the company will resolve it. A written response is encouraged if the dispute is sent in writing.
Keep track of all phone calls. This includes the number dialed, the name of the person you spoke to, the date and a summary of the conversation. Keep copies of any written communications.
Send copies of any correspondence, letters, notes or invoices (not originals), along with the written complaint.
The DOI Complaint form
You can fill out the DOI Complaint Form and have it printed. Also, you can attach copies of supporting documents to your complaint. You can find the form on the DOI website. Or, you can phone them to request a paper copy sent to your home. This will allow them to create a case, eliminate the need to ask for documents and reduce the time it takes to respond. Keep your original documents safe and sound for your records.
The following information should be included with your complaint to ensure that the Department of Insurance has all the information it needs to investigate your complaint.
* Your name, address, and daytime telephone number.
* The exact name of your insurance company
* The full name of any adjuster or agent who might be involved
* Your policy number
* Your claim number and date of loss, if applicable
* A copy of both sides of your insurance cards
* A brief description of the problem
* All supporting documentation including invoices and advertising materials.
What can the Department of Insurance do for you to resolve your complaint?
* Request a written response from the entity to which you have complained.
* Check if the policy or certificate of insurance has been followed.
* Check your file to see if an adjuster, insurance agent or insurance company has violated state insurance laws.
* If laws are broken, take enforcement action.
Although they might not be able to resolve your complaint immediately, DOI can help other policyholders with their complaints and inquiries. Insurance companies may also be more attentive to your concerns if they are involved.
What happens if you file a complaint at the Department of Insurance?
* An acknowledgment letter will be sent to you naming the investigator and providing contact information. The letter will include your Case Number, which is the number of the issue that was submitted to the Department. To send further information to the Department about your case, use the case number.
* You will be issued a new case number, an acknowledgement letter, and contact information for the new investigator if you have any future complaints.
* The DOI will notify your company about your complaint and request a detailed reply. You will receive a copy of their response together with their formal letter concerning the conclusion of our investigation. One of the following actions will be taken as a result of the review:
They will send you a letter explaining how the complaint was resolved.
They will seek corrective action from the company if an insurance law is broken.
They will demand corrective action if the company does not adhere to the policy.
They will demand that the producer or insurer responds to all inquiries or investigates the complaint thoroughly.
What if you’re not happy with Department of Insurance results.
If you are not satisfied with the Department’s response, please contact the Consumer Services Division to ask for a supervisor.
To discuss your concerns, you may want to consult an attorney. Alternate dispute resolution (ADR), which is a process that resolves disputes between you and your insurance company regarding property claims, may be an option. ADR is a method that involves mediation with a neutral party to settle disputes outside of a court of law. For listings of mediators and attorneys, please consult your phone book.
You now have an understanding of the complaints process. The Departments of Insurance are there to protect and regulate consumers and insurance companies. Do not be afraid to ask for their assistance. They exist because of that.
