Complaining to your state insurance regulator
Every state has a regulator that takes complaints about how an insurer handled a claim. This is what it looks at, what it cannot do, and the letter itself.
The short version
A supervisor, not a court
An insurer is licensed by the state it sells in, and that license comes with rules about how a claim is handled. The regulator that issues the license is the body those rules belong to, and it takes complaints from the people the rules exist for.
What that buys you is attention from outside the company. The insurer answers the regulator rather than answering you, in writing, on the regulator’s schedule, and the file stops being a conversation between you and an adjuster.1
What it looks at
Four handling questions
Whether they answered at all
Acknowledging a claim, returning calls, and responding to something you sent. A file where nothing came back is the most legible complaint there is, because the record is the absence.
Whether they explained themselves
A decision comes with a reason, and a reason cites something. What the reason was, and whether the policy provision behind it was quoted, is a handling question rather than a valuation one.
Whether you were asked twice
The same document requested again after you sent it, or a new requirement appearing each time the last one is met. That pattern is visible only in a chronology, which is why the letter is one.
Whether they did what they said
A callback promised for a date, a payment said to be issued, an inspection arranged. A commitment and its date are checkable by somebody who was not there.
What it cannot do
It does not decide what your claim is worth
A regulator supervises conduct. It can require an explanation, put the file in front of somebody senior, and record the complaint against the company. Ordering a payment and setting a figure belong to a court, and this is not one.
So a complaint that argues the offer is too low is addressed to the wrong reader. If the insurer accepts the claim and the disagreement is the amount, the appraisal demand is the document built for that. If the claim was denied, the denial appeal asks the insurer to look again at the reason it gave. This letter is for how the claim was handled, and the three are sent one after another rather than instead of each other.
What to attach
The file a stranger can follow
- The policy, or its declarations page
- Every letter and email in both directions, in date order
- The denial or the offer, in the form it arrived
- A dated log of calls, with who you spoke to
- Anything you were asked for, and proof of when you sent it
An examiner reads this having never seen your claim, so the order and the dates are doing most of the work. The evidence checklist is how the rest of the file is built, and a follow-up log is what turns a run of unanswered calls into the record this complaint is about.
The template
Fill in the brackets and send it
Replace each bracketed field with your own facts and dates, and address it to the regulator in the state your policy was sold in. Nothing here names one for you.
To [Your state's insurance regulator, and the office that takes consumer complaints],
Re: Complaint against [Insurer name], claim [Claim number], policy [Policy number]
What this is about
I am making a complaint about how [Insurer name] has handled a claim on my policy. The loss occurred on [Date of loss] and I reported it on [Date you reported the claim].
What has happened since
[What has happened since, with the date of each step]
What I asked for, and what I received
[What you asked the insurer for, and when you asked]
[What the insurer did or did not do in response, with dates]
What I am asking you to do
[What you are asking the regulator to look at]
I am enclosing copies of the correspondence and the documents referred to above. I am happy to provide anything further you need.
Sincerely,
[Your name]
[Your address, phone and email]
Where your regulator takes complaints through a form on its own site, the same text goes into it, and the copy you keep is the same.2
Disclosures
- 1.Satisfy is not a law firm, does not provide legal advice, and is not a licensed insurance adjuster or public adjuster. This page describes what a state insurance regulator generally supervises. It does not assess any claim, say whether an insurer acted improperly, or state what any regulator will do.
- 2.Which body regulates insurance, how a complaint is filed, what it requires, and the periods an insurer must meet are set by each state. Nothing on this page names a regulator, states a deadline or cites a rule, because none of the three is the same in any two states. Your policy and your state’s regulator are the authorities on all of it.