How to file an insurance complaint

how to file an insurance complaint

Are You Experiencing a Problem with Your Insurance Company or Agent?

The Bureau encourages consumers to try to resolve any problem with their company, plan or agent before contacting the Consumer Services Section. Many times a mistake has been made, and is easy to correct upon inquiry.

Always keep a photocopy of your letter for your records. Keep copies of all e-mail or fax communications as well.

If you decide to file your complaint by telephone with your company or agent, keep a written record of:

  • The date and time of your call,
  • The name of the person you talked to, and
  • What was said during the call

Is Your Problem Still Unresolved After Contacting Your Insurance Company or Agent?

You may file a complaint with the BOI as described below under How Do I File A Complaint. or you may call us first to discuss your concerns. A Consumer Services Representative will be able to address many of your questions or provide assistance that may help you in resolving your complaint. If we cannot assist you by telephone, we will advise you on how to file a complaint.

What Can Consumer Services Do?

  • Thoroughly investigate your complaint.
  • Help you get a clear response to your questions.
  • Cut through red tape.
  • Correct misunderstandings.

What Can Consumer Services Not Do?

  • Recommend a particular company, agent, or product.
  • Recommend or rate an insurance company.
  • Provide legal services that are sometimes required to settle complicated problems.
  • Make medical decisions or require an insurer to pay for services it has determined were not "medically necessary."
  • Identify an insurance company with whom a particular person may have a policy.
  • Dispute an underwriting decision made in accordance with an insurer’s underwriting guidelines.
  • Resolve a dispute that is a question of fact.
  • Require an insurer to pay a claim.

If we are not able to resolve your problem, we will tell you why. If the insurance law and facts are on your side, we will try to see that your rights are protected and that your complaint is resolved in a satisfactory manner.

What Are Some Types of Plans the Bureau does not Regulate?

  • Self-insured employer plans and health and welfare benefit plans (www.dol.gov/ebsa )
  • Medicare (www.Medicare.gov

    )
  • Federal employee plans (www.opm.gov

    )
  • Commonwealth of Virginia employee benefit plan (www.dhrm.virginia.gov

    )
  • Military Insurance plans (e.g. Tricare, etc.) (www.tricare.mil

    )
  • Medicaid (www.dmas.virginia.gov

    )
  • Workers' Compensation Claims (www.vwc.state.va.us

    )
  • Pre-Existing Condition Insurance Plan (www.pciplan.com

    )

What Are My Rights?

Insurance Companies:

  • are not allowed to unfairly discriminate as to premium rates charged or kinds of coverage,
  • are required to pay claims promptly and fairly, and
  • must give the consumer access to certain information collected by the insurance company.

How Do I File a Complaint?

File Online

Please use our Consumer Complaint Portal *

to submit your complaint. This allows you to file your complaint online, communicate with the Bureau of Insurance staff, and electronically upload documents to support your complaint.

*NOTE TO HEALTH CARE PROVIDERS. If you are submitting a complaint on behalf of a particular patient, you must obtain the insured's authorization in order for our office to contact the insurance company on his or her behalf. If you are experiencing problems with an insurance company which are more general in nature, or which involve a number of patients and/or claims, please call our office before submitting the complaint.

File by mail or fax

Select the applicable form below to submit a complaint by mail or fax. If you file this way, your complaint will not be on the online portal. Please attach copies of

all supporting documentation to the completed complaint form. Be sure to keep your original documents for your records.

The forms below are available in Acrobat portable document format (PDF). You may complete the forms using your computer before printing. Use your TAB key to navigate through the forms.

Ethics and Fairness Complaint Form (Provider complaints involving the participating health care provider’s contract with an insurance carrier. The issue must not be an individual controversy, but must involve an issue that constitutes a general business practice.)

*NOTE TO HEALTH CARE PROVIDERS. If you are submitting a complaint on behalf of a particular patient, you must obtain the insured's authorization in order for our office to contact the insurance company on his or her behalf. If you are experiencing problems with an insurance company which are more general in nature, or which involve a number of patients and/or claims, please call our office before submitting the complaint.

When you submit a complaint, please be sure to provide us with the information listed below. This will allow us to handle your complaint much quicker.

  • Your name, address, and the name of the insured person (if different)
  • The name and address of the insurance company and/or the agent/agency
  • Policy or group certificate number, if applicable
  • Claim number and date of injury or loss
  • Type of insurance
  • A detailed explanation of your problem (i.e. what happened, who was involved, and why you think the company or agent is wrong)
  • How you tried to resolve the problem
  • What you think the company or agent should do (pay a claim, make a refund, etc.) to resolve your problem

To thoroughly review your concerns, we ask that you provide as much detail as possible when you submit your complaint. You may mail or fax your complaint. Please attach copies of all supporting documentation to the completed complaint form. Be sure to keep your original documents for your records.

  • Fax Information: The Life and Health Consumer Services fax number is (804) 371-9944.

The Property and Casualty Consumer Services fax number is (804) 371-9349.

Use our fax cover sheet .
  • Mailing Address: State Corporation Commission, Virginia Bureau of Insurance, P.O. Box 1157, Richmond, VA 23218.
  • Street Address: State Corporation Commission, Virginia Bureau of Insurance, 1300 East Main Street, Richmond, VA 23219.
  • If you wish to discuss your complaint or receive assistance on how to file a complaint, you can call our toll-free number, 1-877-310-6560, or contact the section directly. You may reach our Life and Health Consumer Services Section at (804) 371-9691 or the Property and Casualty Consumer Services Section at (804) 371-9185.

    How Soon Should I Expect a Response from the Bureau of Insurance?

    Within a week after we receive your written complaint, we will assign a file number and send you a letter acknowledging receipt of your complaint.

    What Contact will be made with the Insurance Agent or Company?

    In most cases, a letter and a copy of your complaint will be sent to the company or agent, requesting an explanation of its position. Telephone contact may be made to discuss the complaint, to ask questions, or to make specific requests. After the company or agent responds, we will determine what further actions, if any, we will take.

    How Long Will the Investigation Take?

    Normally, it takes about 45 days after we receive a complaint to provide our written response. However, it may take longer if your complaint is claim related, or involves a unique or complex problem, or requires the insurer or agent to conduct extensive research.

    Should I call to check on the Investigation’s Progress?

    You do not need to call. We will keep you informed and advise you of the outcome of our review.

    If you have additional information, send it to us in writing. (Include the file number we assigned in our letter of acknowledgment, and send it to the person investigating your complaint.)

    Source: scc.virginia.gov

    Category: Insurance

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