Filing a California Department of Insurance Complaint

What Is the California Department of Insurance?

The California Department of Insurance (CDI) is the state agency that regulates the insurance industry in California. It's headed by the Insurance Commissioner, an elected official with authority to investigate complaints, enforce insurance laws, and take action against insurers who violate California regulations.

The CDI has significant power over insurers doing business in California. It can:

• Investigate consumer complaints against insurance companies
• Order insurers to pay valid claims they've wrongfully denied
• Fine insurers for violations of the Insurance Code
• Suspend or revoke an insurer's license to do business in California
• Refer cases to the Attorney General for prosecution

When to File a CDI Complaint

A CDI complaint is appropriate when your insurer has violated California insurance laws or regulations. Common reasons to file include:

Good Reasons to File

• Claim denied without proper investigation - California requires insurers to fully investigate before denying
• Unreasonable delays - California has strict timelines for claim handling (see below)
• Failure to communicate - Insurers must respond to your inquiries within 15 days
• Lowball settlement offers - Offers that don't reflect the actual value of your loss
• Misrepresentation of policy terms - Insurer incorrectly explaining what's covered
• Failure to provide claim forms - Required within 15 days of notice of claim
• Threatening or intimidating conduct - Adjusters using improper pressure tactics

When a CDI Complaint Won't Help

• Policy interpretation disputes - If coverage genuinely doesn't exist, CDI can't create it
• Premium disputes - CDI has limited authority over rate disagreements
• ERISA-covered plans - Employer health plans are federally regulated, not by CDI
• Medicare/Medi-Cal issues - Different agencies handle these programs
• Workers' compensation - Handled by the Division of Workers' Compensation

How to File a CDI Complaint: Step-by-Step

CDI Investigation Timeline

CDI handles thousands of complaints annually. Here's what to expect timeline-wise:

What CDI Can and Cannot Do

What CDI CAN Do

• Contact your insurer and demand a response to your complaint
• Review your claim file to identify violations of California law
• Facilitate communication and resolution between you and your insurer
• Order insurers to reconsider improperly denied claims
• Fine insurers for violations of the Insurance Code
• Refer patterns of abuse for enforcement action
• Provide written findings documenting violations (useful for later litigation)

What CDI CANNOT Do

• Order insurers to pay a specific amount - They can say "pay the claim" but can't set the dollar figure
• Award you damages - No punitive damages, emotional distress, or attorney fees
• Represent you in court - CDI is not your attorney
• Force settlement - CDI can pressure but not compel insurers
• Interpret policy language - Genuine coverage disputes require court resolution
• Handle non-insurance disputes - Must be regulated by CDI

Writing an Effective Complaint

Your complaint should be clear, factual, and focused on specific regulatory violations. Here's how to structure an effective complaint:

Opening: Identify the Basics

• Your full name and contact information
• Insurance company name
• Policy number and claim number
• Date of loss and type of claim

Body: Describe What Happened

Provide a chronological narrative of events. For each event, include:

• Date of the event
• What happened (what the insurer said or did)
• How it violated California insurance law (be specific if possible)
• How it harmed you

Closing: State What You Want

Be specific about the resolution you're seeking:

• "I request that CDI investigate and order [Insurer] to pay my claim"
• "I request that CDI cite [Insurer] for violations of Cal. Code Regs. tit. 10, Section 2695.7"
• "I request mediation assistance to resolve this claim"

After Filing: What to Expect

Initial Response

You'll receive a confirmation letter with your complaint number within 1-2 weeks. This letter will include the name and contact information for your assigned analyst.

Investigation Phase

The CDI analyst will contact your insurer and request a response. The insurer must provide their claim file and explain their handling of your claim. This typically takes 30-60 days.

Resolution

CDI will send you a written response explaining their findings. Possible outcomes include:

• Violation found - CDI documents the violation and may order corrective action
• No violation found - CDI explains why the insurer's conduct was lawful
• Facilitated settlement - Your insurer agrees to reconsider or pay your claim
• Referral - Complex cases may be referred for further investigation or enforcement

If You're Dissatisfied

CDI decisions are not legally binding, and there's no formal appeal process. However, you can:

• Provide additional information and ask for reconsideration
• Request to speak with a supervisor
• File a lawsuit in court (you always retain this right)
• Use the CDI findings as evidence in litigation

CDI Contact Information

CDI Complaint vs. Lawsuit

A CDI complaint and a lawsuit serve different purposes and can be pursued simultaneously.

CDI Complaint Advantages

• Free - No filing fees or attorney required
• Faster - Typically resolved in 2-4 months
• Regulatory pressure - Insurers take CDI investigations seriously
• Creates a record - CDI findings can support later litigation

Lawsuit Advantages

• Damages - Can recover emotional distress, punitive damages, attorney fees
• Binding - Court judgment is enforceable
• Discovery - Full access to insurer's internal documents
• Policy interpretation - Court can decide coverage disputes

Related Guides