Most insurance adjusters want to handle claims as quickly and easily as possible. But some adjusters will try to intimidate or frustrate you into accepting a settlement for much less than your claim is worth.
You have a few options when an adjuster is unresponsive or makes an unreasonable counteroffer. One option is to file a complaint with the insurance department in your state.
In this article, we'll explain when and how to file a complaint against an insurance company. We'll use the example of a personal injury claim here, but you can take the same steps in disputes over other types of insurance claims.
If your goal is to reach a settlement with the insurance company, you should take the following steps before you file a formal complaint.
Give the adjuster a fair chance to settle your claim before you escalate the dispute. Your claim is the most important claim in the world to you, but the adjuster has to deal with dozens of claims at the same time.
Talk to the adjuster in a calm, businesslike manner about the problem. You might have to call or write many times. If the adjuster is unresponsive, be persistent and patient. Try to set up an appointment to talk or a deadline for receiving a response to your demand letter.
When an adjuster stubbornly denies your claim or insists on an unreasonably low offer, get it in writing. You'll want documentation of the adjuster's position when you go up the chain of command.
If you can't get anywhere with the adjuster, ask to speak to an immediate supervisor or the claims manager. The adjuster might be overwhelmed with claims or might not have the authority to make you the offer you deserve. A supervisor will take a look at your claim with fresh eyes and more discretion to negotiate a settlement.
If your situation seems appropriate for a complaint to the state insurance department, the mere mention of your intent to file a complaint might bring a new settlement offer. Even though the insurance department is unlikely to get involved, insurance companies would rather not have complaints against them on file. Too many complaints looks bad for individual adjusters and the company.
Insurance companies have a duty to negotiate and settle claims in good faith. If you believe an insurance company is negotiating in bad faith, use that term in your conversation with the adjuster about filing a complaint. If that doesn't work, consider putting your accusation of "bad faith" in writing.
Bringing up bath faith often gets prompt attention and might be enough to change an insurance company's position. If you can prove that an insurance company acted in bad faith, you can sue the insurance company for damages (money). The rules about what is and is not bad faith vary from state to state.
Filing a complaint over a personality clash with an adjuster isn't likely to go anywhere. But a complaint might be worth pursuing when an adjuster:
If you and the adjuster disagree about the value of your claim, learn how to respond to a low personal injury settlement offer.
If mentioning the possibility of a complaint to the state department of insurance doesn't get any movement from the adjuster or supervisor, file an actual complaint.
Your first step is to figure out exactly where to send your complaint and whether there is a specific form to use. The National Association of Insurance Commissioners (NAIC) website links to each state's department of insurance with information about how to file a complaint.
If your state has a complaint form, get it and use it. Otherwise, your complaint letter should include the following:
Use the sample letter below to get started on your complaint.
Your complaint to the state insurance department can accomplish several things. First, the claims manager or director will hear about your claim and learn that you're someone who intends to do whatever it takes to get a fair and reasonable personal injury settlement. Your persistence alone may inspire a reasonable settlement offer. Also, because a complaint with the state insurance department adds an extra layer of work for the insurance company, the company will want to try harder to settle your claim.
On rare occasions, an investigator for the state insurance department actually speaks in person to an insurance company on a claimant's behalf. This may get the insurance adjuster to make a more reasonable settlement offer. At the least, it will probably force an explanation of why the insurance company is taking such a hardline position, which you can use in your negotiations.
The quality, quantity, and speed of the response you'll receive from your state departments of insurance vary greatly from state to state. In a few states, every complaint gets at least some attention from the department's consumer affairs office. In other states, however, your complaint may get action only if the office spots obvious and extreme improper conduct, or if it has received numerous other complaints about the same adjuster or insurance company.
The NAIC collects data submitted by state insurance departments about why people file complaints and how their complaints are resolved. In 2021, most people complained about delays in handling claims, and most complaints resulted in a compromise by settlement or resolution. Nearly 13,000 complaints resulted in the insurance company's position getting overturned.
You don't have to hire a lawyer to file a complaint. You can represent yourself throughout the insurance claim process and even in court if you decide to file a personal injury lawsuit.
But sometimes you need the help of a lawyer who has experience dealing with insurance companies. If you're dealing with serious injuries or complex legal issues, hiring a lawyer is well worth the cost. A lawyer can help you figure out how much your claim is worth and negotiate with the adjuster on your behalf. A lawyer can also help you file a lawsuit, which might be what it takes to get the insurance company to make a fair offer.
Learn more about how to decide whether to hire a personal injury lawyer or handle your own claim. You can also connect with a lawyer directly from this page for free.
The following letter should help you get started on your own complaint:
This article and sample letter are excerpted from How to Win Your Personal Injury Claim by Attorney Joseph Matthews (Nolo).