How to File an Insurance Complaint against Insurance Companies?

How to File an Insurance Complaint against Insurance Companies?

The government gives insurance consumers the right to file a complaint against insurance companies, insurance agents and dealers. Insurance agencies regulate automobile (a auto insurance), homeowner’s, renter’s, various health, life, nursing home, credit life, credit disability and pet insurance.

Firstly, you must try to solve the problem yourself:

If you have a complaint, call your insurance company first. Many complaints can be solved by just calling the company and talking to them about your issue. Most insurance companies have toll-free telephone numbers for customer assistance. If you are in dispute with your health plan over appropriate care your health plan has an internal process to hear your appeal that you MUST go through before to contacting the Government.

• You must call to your agent first. If you are unable to resolve your complaint, ask to speak to a supervisor.

• You must have your policy number ready.

• You must ask for a written response to your complaint.

• You must follow up in writing. Describe your complaint and how you want the company to resolve it.

If you’re still not satisfied, call the Insurance Board of department.  

• You must explain your problem and they suggests any additional steps you should take to resolve the problem.

• The Board will decide if the company, agent, or broker broke the insurance laws or administrative rules and take action if laws or rules are broken.

Information you need while filling complain against Insurance Company:

• The name and address of the Insurance Company or agent.

• Your policy number, identification number and the name of your group, etc.

• A description of what happened, who was involved.

• If your complaint is against some other person’s insurance company then include that person’s name and policy number plus your claim number.

• Letters you have written to the company or agent about the problem, and letters they have written to you.

• Your policy or the part of your benefits handbook about the disputed coverage - please mark the section you feel supports your complaint.

• Letters written by other persons (such as your doctor or lawyer) about the complaint.

• Sales literature or copies of worksheets if these are relevant.

• The claim you filed with the company if a claim is involved.

• Letters written by other persons (such as your doctor or lawyer) about the complaint.

• Your health card if a health claim is involved.

• Detail regarding the solution you are seeking (e.g., pay a claim, issue a refund, etc.).

*Do not send originals. Do not send us your medical bill, unless there is a specific problem with the bill itself.

What will the investigation involve?

• The Board will send the company a copy of your complaint and ask for an explanation of its position. The Board Member consists of

·        A person nominated or designated by Government.

·        Representative, Ministry of Law

·        Representative, Ministry of Finance

·        A person from Government from among the persons having the special knowledge in the Insurance Business etc.

• The Board will calls the company’s response to make sure it has correctly addressed your problem.

• The Board will send you a letter that explains the results of the investigation.

What happens if the company refuses to corrects my problem?

• If there is no evidence of violations, the Board letter will say so and explain why we are closing the investigation.

• If any *Insurer or Insurance Agent or Broker has made any Insurance Business without following the procedures to be followed pursuant to the Act, the Board may fine him with cash punishment or imprisonment in the jail.