Every state has an agency that oversees the insurance industry. And each of these agencies has a consumer complaint division that occasionally gets involved when a claimant is having trouble with an insurer. Intervention by the state agency is rare when it comes to individual insurance claims, but in this article we'll explain when and how to file a complaint (or just threaten to take action, in order to motivate the insurance company to take your claim seriously). We'll frame the issue as one involving a personal injury claim, but this information applies to most types of insurance claims.
There are a few circumstances in which a complaint to a state department of insurance might bring some results, including when the insurance adjuster:
On the other hand, don't file a complaint when the insurance company has made a settlement offer but you differ on how much your claim is worth. Instead, learn how to respond to a low personal injury settlement offer.
If your situation seems appropriate for a complaint to the state insurance department, the mere mention to the adjuster of your intent to file such a complaint might bring a new settlement offer. Even though the insurance department is unlikely to get involved, adjusters would rather not have such a complaint on file. Too many of these complaints can result in an insurance department inquiry, and individual adjusters do not want to have these complaints in their own personnel files.
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 call and find out exactly where to send your complaint and whether there is a specific form to use. Do an online search for "[name of your state] department of insurance," and find the agency's website. If you find there’s a form, get it and use it. Otherwise, your complaint letter should include the following:
The quality, quantity, and speed of response from state departments of insurance varies 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.
Your complaint to the state insurance department can accomplish several things. First, someone in the claims department of the insurance company other than the adjuster who handled the claim will become aware that there is a claimant who intends to do whatever it takes to get a fair and reasonable personal injury settlement, and that may inspire someone to take another look at your claim and come up with 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, an explanation the investigator may pass on to the claimant.
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).