We Can or Cannot Do

This is what we CAN do:

• Forward a copy of your complaint to the insurance company, if appropriate:
• Obtain information or explanations on your behalf from the insurance company or their representatives. This may involve written and verbal contact with such companies or persons;
• Review in detail the information obtained from the company for compliance with statues, regulations and policy contracts;
• Explain the provisions of your insurance policy, as appropriate
• Suggest to you actions or procedures that you may take which could aid in resolving your insurance problems
• If it is determined that the actions of an insurance company are in violation of a statute, regulation or policy that the Division enforces we may take corrective action against that company

This is what we CANNOT do:

• Assume the role as your legal representative in or out of court
• Intervene in a pending lawsuit on your behalf
• In the case of disability insurance complaints, make a medical decision as to the extent of an individual's disability. We investigate complaints involving disability insurance to determine (1) whether or not the denial decision is arbitrary or capricious and (2) whether or not the denial decision was rendered in accordance with the terms of the insurance contract and State insurance laws and regulations
• Address complaints or inquiries involving insurance contracts that are not subject to the jurisdiction of the insurance laws of the State or matters governed by other State or Federal agencies. This would include the following:
  • Self-funded or self-insured plans (U.S. Dept of Labor)
  • Medical Assistance (Medicaid) (HIP)
  • Medicare and Medicare HMO's (FSAA) (SHIP)
  • Federal Employee Health Benefit Programs (US Office of Personnel Management)
  • Workers' Compensation (Workers Compensation)
  • Contracts issued and delivered to the policy holder in another state
  • See IDOI Jurisdiction for more information

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.

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 any documents (copies) related to your problems, such as the declaration page of your insurance policy or certificate, cancelled checks, letters of claim denial or other correspondence. Do not send us originals of any 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.