How To File A Complaint About Your Insurance Company – Forbes Advisor

How to complain about insurance company

If you have a complaint about your insurance company, where do you go? That’s what Dianne Zeitler wanted to know after breaking her arm while she was traveling through Vienna, Austria.

“When I asked my insurance company to reimburse me for the emergency surgery, they denied my claim twice,” says Zeitler, a retired health care consultant from Washington, D.C.

Like many policyholders, you were faced with a variety of options for filing a complaint. should you appeal to someone from your insurance company? complain to your state insurance commissioner? Or should I call a lawyer?

“When an insurance company chooses not to honor its contract or comply with the law, the policyholder has several options,” says Jeff Raizner, partner at Raizner Slania, a Houston law firm specializing in litigation. of insurance.

If you want to file a complaint about your insurance, these are the most common options:

  1. Contact your insurance agent.
  2. Write to an officer of the insurance company.
  3. Ask a third party, such as an ombudsman, to help you with your dispute.
  4. File a complaint with your state insurance department, which regulates insurance business and insurer compliance with state laws and regulations.
  5. seek arbitration if that is an option in your policy.
  6. file a legal claim against the insurer in court.

zeitler initially chose door no. 3. filed a complaint with the appeals department of his insurance company, which is overseen by a third party because it is government operated. but he also covered the bets of him opening the door no. 2. He found the names of the board of directors and executives of the insurance company and sent them a polite appeal.

“I included a timeline of the claim, names and departments I spoke with, and copies of the bills,” she says.

want to complain about your insurance company? start here

If you bought your policy through an agent, you can try to recruit that person as an advocate to help you with your complaint.

“If you’re having trouble getting the payment you’re owed or any other problem, your first line of defense is your local agent,” says Corinne Kligmann, partner at Lift Financial, a financial advisory firm in South Jordan, Utah. . “Her interests are with yours, not with those of the insurance company. they can be a great ally and are by far the easiest way to achieve a good result.”

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If that doesn’t work, Kligmann recommends contacting the agent’s manager. “That’s the next step in navigating the process. If your agent can’t help you, there’s almost always a manager to talk to for help. in most cases, you don’t need to go any further than this,” he says.

appeal to an executive

Next, talk to your insurance company, says George Beighley Jr., an attorney specializing in medical malpractice at the Richardson Plowden Law Firm in South Carolina.

Insurance companies have an appeal process that you must follow before requesting outside assistance. Although your insurance company may not voluntarily provide information about the appeal process, you should ask about it before filing a complaint with an outside party.

that’s what beighley did when he was involved in a case involving an out-of-network claim for a health care provider. He points out that some insurance companies have hidden appeal options on their websites.

Depending on the insurance company, you may need to file an appeal in writing, and generally you must appeal a denied claim within a certain period, such as 180 days.

complain to an ombudsman

Some state insurance departments have an ombudsman (basically an advocate on staff) who can try to resolve your complaint.

“This is a designated official to protect you and investigate any complaints,” explains Lisa Lindsay, executive director of the Private Risk Management Association, a nonprofit educational organization. “they are there to defend you and be a watchdog to take care of any problems that come up. If he hasn’t or can’t make progress with his agent or agency manager, this would be the next step to take.”

for example, the california department of insurance has an ombudsman charged with ensuring that the department “provides the highest level of customer service to our consumers, insurers, agents, brokers, and public officials.” The New Jersey Ombudsman assists consumers with issues related to insurance availability, claims processing, coverage questions, and other issues related to insurance consumer education and assistance.

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If the ombudsman approach doesn’t work, you may also consider going public with your complaint. A request for help on social media can get the attention of your insurance company.

“This way, you can let other consumers know how the company handles problems so they can bypass that company when looking for insurance,” says Rick Sabo, an investment fraud and insurance expert who owns an independent financial entity. planning company.

file a complaint with state regulators

states regulate insurance companies, thanks to the mccarran-ferguson act, a 1945 federal law that exempted the insurance business from federal regulation.

State insurance departments are the official handlers for filing complaints about insurance problems.

“Typically, they will be involved in an investigation of the matter,” says Dennis Sawan, a personal injury attorney in Toledo, Ohio. “They will also allow the insurer to explain their view of the situation. upon adjudication, the agency will certify that no insurance law was violated or, if an insurance law was violated, refer it to the division of market conduct for enforcement.”

Complaints to the state department of insurance are not guaranteed to work. In Ohio, the Department of Insurance explicitly says that it will not force a company to satisfy you if the laws have not been broken, even if you believe the company or agent has not been fair.

Each state insurance department divides the number of complaints by the company’s share of premiums and calculates a complaint ratio. the higher the rate of complaints, the higher the level of complaints.

The National Association of Insurance Commissioners has a tool to find complaint rates. the industry average rate is always 1.00, so any rate above 1.00 indicates a higher than average level of complaints and a company to possibly avoid.

michael mccready, managing partner of personal injury law firm mccready law in chicago, says that in his experience, a company’s complaint rate has a direct correlation to the quality of the company. “There are poor operators who don’t even answer the main phone line,” he observes.

take your complaint to arbitration

arbitration may be an option for some issues.

“Your policy will state how or where disputes will be handled,” says Marc Fitapelli, a partner at New York law firm MDF Law. “There is a growing trend towards arbitration. however, arbitration is only available if the policy explicitly requires it. if the policy says nothing, then the parties will have to litigate in court.”

There are two types of arbitration:

  • binding
  • nonbinding

“With no binding, you can disagree with the arbitrator’s decision and file a lawsuit,” explains adria goldman gross, an advocate for medwise insurance advocacy. “Insurance companies generally require binding arbitration on their policies, if they allow arbitration at all.”

hiring a lawyer

Sometimes you need the help of a professional who is used to dealing with insurance companies. That’s when to call an attorney for an insurance problem.

You may need one, especially if you have a large, expensive claim or a complex claim.

If your claim seems to be going wrong, it’s better to hire an attorney earlier in the process rather than wait for a denial.

sometimes it works

the zeitler case had a happy ending.

“Two days later I received an email from an executive profusely apologizing,” he recalls. “He said that he felt they mishandled the entire claim and promised to re-educate the staff involved.”

You also received a check for the full amount of your claim.

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