Complaints

The Consumer Services Division accepts complaints and compiles reports so the public can evaluate the companies and agents who conduct insurance business in Indiana.

Before you file a complaint with the IDOI you should first contact the insurance company, agent or broker in an effort to resolve the issue(s). If you do not receive a satisfactory response, then you may file a complaint with the Division. When filing a complaint please provide as much information as possible. Failure to provide this information may delay or even prevent our ability to be of assistance. Please be aware that a copy of your complaint will be provided to the insurance company. If the insurance company has not followed the terms and conditions of your policy, you may submit a consumer complaint form.

Examples of appropriate issues include:

• Coverage Concerns
• Claim Disputes
• Premium Issues
• Policy Cancellations
• Refunds

In order for us to effectively begin our investigation you will need to provide supporting documentation with your complaint. Failure to provide supporting documentation may delay your request. Supporting documentation includes evidence and documents related to your policy and complaint, such as the declaration page of your insurance policy or certificate, cancelled checks, letters of claim denial, or other correspondence. Please do not send us original documents, photographs, or other evidence as we are not responsible for lost records or other items. The more complete the information we receive, the quicker we can identify the issues and begin our review. Once the complaint information has been collected, we thoroughly investigate all circumstances and take administrative action against the company or person(s) at fault when appropriate.

• Types of Issues Handled by IDOI
• What We CAN Do
• What We CANNOT Do
• Filing a Consumer Complaint
• Healthcare Providers (Doctor or Hospital)
• Claim Tips

Complaint Process

• Your submitted complaint will be processed typically within 72 hours of receipt.
• You will receive a confirmation letter from the Consumer Services Division acknowledging the receipt of your complaint with your problem report number listed along with the name of the Consultant handling your file. Please always refer to this Problem Report number in any correspondence with your Consultant regarding your complaint.
• Your complaint along with a letter from the IDOI will be mailed to the insurance company or agency the complaint is against. By Indiana law, an insurance company has 20 business days to respond in writing to the IDOI.
• After receipt of the response, the IDOI will send you a copy of the company's response along with our response.
• Your complaint will be kept on file at the Department of Insurance and will become a public record.

The Online Consumer Complaint Portal is the preferred & most efficient method of filing a complaint.

You may submit a consumer complaint online following the link above or print the complaint form and mail or fax it to:

Jurisdiction of IDOI

The IDOI has the authority to regulate (i.e., license, review rates and policies, review financial statements, investigate complaints, conduct examinations and issue orders/penalties) all insurance companies, producers, and HMO's that are licensed to conduct business in Indiana.

Generally, Indiana law does not apply to insurance contracts (or policies) issued in other states. For example, if your policy was issued in Ohio, then Ohio law and not Indiana law applies to your coverage. In these instances, you will need to contact the Regulator in that state for assistance.

In addition, employer self-funded plans also fall outside of the agency's jurisdiction. Self-funded plans are those where your employer pays for your medical expenses, rather than contracting with a health plan to do so. The U.S. Division of Labor regulates self-funded plans, and therefore, has the authority to investigate and resolve complaints against such plans.

The IDOI does not have jurisdiction over federal programs such as the Federal Employee Health Benefit Program (FEHBP), Medicare, Medicaid, HIP, Workers Compensation and Social Security. Please contact the appropriate regulatory authority for additional information on these programs.

Report Fraud

To regulate the insurance industry and cut down on fraudulent activity the IDOI and the NAIC ask that any suspected fraudulent activity regarding insurance brokers, insurance companies, or insurance plans be reported.

If you have been a victim or have witnessed Insurance Fraud, please contact the NAIC.

For information regarding fraudulent insurance activity in Indiana, please contact:

Mail to:

Fax: 317-234-2103

Email: mhiggins@idoi.in.gov