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How to File a Complaint Against an Insurance Company

How to File a Complaint Against an Insurance Company for Unfair Insurance Practices

The Insurance Code of California includes laws which apply to insurance companies, but the Department of Insurance has no power to force an insurance company to pay claims. However, if an insurance company acts unfairly in dealing with your claim, you should file a complaint.

Unfair Insurance Practices
Insurance Code 790.03(h), which is called the Unfair Practices Act sets forth a variety of acts by an insurance company that are considered unfair practices and therefore are improper. Enforcement is the responsibility of the DOI (“Department of Insurance”))

What is an Unfair Insurance Practice?
*** Misrepresenting to claimants pertinent facts or insurance policy provisions relating to any coverages at issue *** Failing to acknowledge and act reasonably promptly upon communications with respect to claims arising under insurance policies *** Failing to affirm or deny coverage of claims within a reasonable time after proof of loss requirements have been completed and submitted by the insured # Not attempting in good faith to effectuate prompt, fair, and equitable settlements of claims in which liability has become reasonably clear Compelling insured’s to institute litigation to recover amounts due under an insurance policy by offering substantially less than the amounts ultimately recovered in actions brought by the insured’s when the insured’s have made claims for amounts reasonably similar to the amounts ultimately recovered

What are some more Unfair Insurance Practices?
*** Failing to settle claims promptly when liability has become apparent under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage *** Failing to promptly provide a reasonable explanation of the basis relied on in the insurance policy in relation to the facts or applicable law for the denial of a claim or for the offer of a compromise settlement *** Directly advising a claimant not to obtain the services of an attorney

How to File a Complaint with the Department of Insurance
Before you file a complaint with the California Department of Insurance, you should first contact the offending insurance company, and try to resolve the issue. If you do not have any luck, then file a complaint form, or REQUEST FOR ASSISTANCE, with the Department of Insurance. Please note that a copy of your Request for Assistance may be provided to the insurance company, agent or broker unless you state that you do not want a copy forwarded. I suggest forwarding a copy of
the Request to the Insurance Company yourself.

Provide Supporting Documentation with your Request For Assistance.
Failing to attach supporting documents may delay your request. Supporting documentation includes COPIES of the declaration page of your insurance policy or certificate, canceled checks, letters of claim denial or other documents. Do not send originals of any documents, photographs or other evidence as you will probably not get them back. The more complete the information the department gets from you, the quicker it can identify the issues and begin a review of the insurance company practices.

How to Contact California Department of Insurance
California Department of Insurance Consumer Communications Bureau 300 South Spring Street, South Tower Los Angeles, CA 90013 1-800-927-HELP (4357) or 213-897-8921 HOURS are 8:00 a.m. – 5:00 p.m., Mon. – Fri.

How to Obtain Request for Assistance Form
Go to http://www.insurance.ca.gov/contact-us/0200-file-complaint/printable-rfa.cfm


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