State Departments of Insurance report that dissatisfaction with claims settlements is the top reason consumers file complaints with them. Sometimes it's the insurer's fault, and sometimes it's the policyholder's fault for not having the right coverage.
Today I will walk you through the process of filing an insurance claim complaint. I will use the procedure here in the state of Georgia where I live. The process in your home state is very similar and can be found on the website of each state's Department of Insurance. Or you Treuhänder can call your Department of Insurance and they will likely either tell you how to do it or send you printed information on the complaints procedure.
You can file a complaint with the Ministry of Insurance if you cannot resolve your dispute directly with your company. You can even submit your complaint if you have not yet gone through the assessment process (which you can find on your policy).
The Department of Insurance's Consumer Services Division provides consumer information and investigates complaints about companies and manufacturers. They handle most insurance issues related to home, business, auto, health, HMO, life, credit, dental, etc. These issues can include coverage issues, claim disputes, premium issues, mis-declarations, policy cancellations, and refunds, to name a few . They will also investigate a complaint against a public expert.
The Consumer Services Division will not:
provide you with legal advice or act as your attorney;
o recommend an insurance company, agent or policy; o resolve a dispute when the only evidence is your word against the expert's, manufacturer's or company's word; o Making determinations as to the facts of a case. For example, they will not determine who is at fault in an accident or determine the disputed value of damaged or stolen property; o Resolve complaints against service providers such as body shops and restoration companies, unless the complaints relate to insurance company actions. For example, they could resolve complaints against a restoration contractor that the insurance company has requested from you;
o Make medical judgments.
The Insurance Office recommends:
o Read your policy carefully. It's important to know what your policy covers before you suffer any damage. If you have any questions about the coverage you have purchased, ask your agent for an explanation.
o Keep copies of all correspondence between you and the insurance company. When communicating with your insurance carrier, write down the phone numbers you called, the date and time of the call, and the name and title of the person you spoke to. After the call, take notes of what was discussed.
o Ask the company for the specific language in the policy that relates to your claim. Determine if the disagreement is because you and the insurance company interpret your policy differently. If there is a disagreement about the wording in the policy, you may contact the Consumer Services Division by filing a complaint and providing documentation that contains the policy wording in dispute.
o If possible, take photos or videos of your content in your home and do it regularly, which will help in case of loss. Keep the pictures or videos in a locker or somewhere other than home.
Avoiding car and homeowner claims
o Keep all receipts for repairs you make after damage to your property. Auto and homeowner's policies may require you to make reasonable and necessary repairs to protect your property from further damage. Your policy will cover the cost of these repairs. Keep the damaged property for inspection by the claims adjuster. If possible, take photos or video of the damage before making temporary repairs.
o Do not make any permanent repairs until the inspector has examined the damage.
o Ask the adjuster for a detailed explanation of the claims settlement offer. For homeowner claims, this should include sales tax, depreciation and retention write-offs for policies with replacement cost coverage. Withheld depreciation is an amount of money that is being withheld from your claims adjustment until repairs are completed or the items are replaced. Ask how the appraiser determined the estimated amount.
o Be prepared to discuss your claim if there is a disagreement about the Settlement Offer. The more documentation you have on the items you own, the easier the process will be.
In the event of a claim, first contact your insurance company.
When you contact your insurance company, have your policy number ready. Ask where your written challenge needs to be sent. State your complaint and how you expect the company to resolve it. Submitting the dispute in writing encourages a written response.
Document your phone calls by noting the phone number Treuhänder called, the name of the person you are talking to, the date of the call and a brief synopsis of the call. Keep copies of all written communications.
In addition to the written complaint, send copies (not originals) of letters, notes, invoices, canceled checks, promotional materials, or other documents supporting your complaint.
The DOI Complaint Form
The DOI Complaint Form is a document that can be completed, printed and submitted along with copies of any documents supporting your complaint. Obtain this form from the DOI website or call and request a copy in the mail. This will allow them to set up a case and eliminate the need to request documents and reduce the delay in providing a response. Always keep your original documents for your records.