DOI Complaint Template | Insurance Department Complaint

When to File a DOI Complaint

The Department of Insurance (DOI) in each state regulates insurance companies and can investigate complaints from consumers. While the DOI typically cannot order an insurer to pay your claim, their involvement often motivates insurers to take your complaint seriously.

Common Reasons to File

Unreasonable Delays

Failure to respond to communications or process claims within required timeframes.

Improper Denials

Denying claims without adequate investigation or valid policy basis.

Unfair Settlement Practices

Lowball offers, refusing to negotiate, or misrepresenting coverage.

Missing Explanations

Failing to provide written reasons for claim denials or decisions.

Improper Rescission

Canceling your policy improperly or without proper notice.

Claim Handling Misconduct

Any pattern of behavior that violates state insurance regulations.

💡 What the DOI Can and Cannot Do

The DOI can investigate, mediate, and impose penalties on insurers. However, they generally cannot order an insurer to pay your claim - that requires a lawsuit. Still, a DOI complaint creates a regulatory record and often prompts insurers to settle disputes to avoid regulatory scrutiny.

🐻 California Department of Insurance

California's CDI is one of the most active state insurance regulators. You can file a complaint online at insurance.ca.gov or by mail. Key California-specific considerations:

Reference violations of Cal. Code Regs. tit. 10, Section 2695.1 et seq. (Fair Claims Settlement Practices)
The CDI has specific forms and an online portal for complaints
California Insurance Code Section 790.03 lists unfair practices that are actionable
For health insurance, also consider filing with the Department of Managed Health Care (DMHC)

The Template

This template is designed to be adapted for your state's DOI. Most states accept written complaints, though many also have online portals. Use this as a starting point and customize for your specific situation and state requirements.

DOI Complaint Letter

[YOUR NAME] [YOUR ADDRESS] [CITY, STATE ZIP] [YOUR EMAIL] [YOUR PHONE] [DATE] [STATE] Department of Insurance Consumer Services Division [DOI ADDRESS] [CITY, STATE ZIP] Re: Complaint Against [INSURANCE COMPANY NAME] Policy Number: [POLICY NUMBER] Claim Number: [CLAIM NUMBER] Type of Insurance: [AUTO / HOMEOWNERS / HEALTH / LIFE / OTHER] Dear Consumer Services Division: I am filing this formal complaint against [INSURANCE COMPANY NAME] for violations of [STATE] insurance regulations in handling my insurance claim. I request that the Department investigate this matter and take appropriate action. PARTIES Complainant (Myself): Name: [YOUR FULL LEGAL NAME] Address: [YOUR ADDRESS] Phone: [YOUR PHONE] Email: [YOUR EMAIL] Insurance Company: Name: [INSURANCE COMPANY FULL LEGAL NAME] Address: [INSURANCE COMPANY ADDRESS] Policy Number: [POLICY NUMBER] Claim Number: [CLAIM NUMBER] Adjuster Name: [ADJUSTER NAME, IF KNOWN] SUMMARY OF COMPLAINT I hold a [TYPE OF POLICY - e.g., "homeowners insurance policy"] with [INSURANCE COMPANY NAME], Policy Number [POLICY NUMBER]. On [DATE OF LOSS], I suffered a loss when [BRIEF DESCRIPTION OF LOSS]. I filed a claim on [DATE CLAIM FILED] and was assigned Claim Number [CLAIM NUMBER]. Since filing my claim, [INSURANCE COMPANY NAME] has [BRIEF SUMMARY OF PROBLEM - e.g., "failed to respond to my communications," "unreasonably denied my claim," "offered a settlement far below my actual damages"]. TIMELINE OF EVENTS [DATE 1]: [EVENT - e.g., "Loss occurred (water damage from burst pipe)"] [DATE 2]: [EVENT - e.g., "Filed claim with insurance company by phone"] [DATE 3]: [EVENT - e.g., "Adjuster [NAME] inspected property"] [DATE 4]: [EVENT - e.g., "Received initial settlement offer of $X"] [DATE 5]: [EVENT - e.g., "Sent written dispute with contractor estimate"] [DATE 6]: [EVENT - e.g., "No response received despite follow-up calls"] [ADD ADDITIONAL DATES/EVENTS AS NEEDED] REGULATORY VIOLATIONS I believe [INSURANCE COMPANY NAME] has violated the following [STATE] insurance regulations: [SELECT AND CUSTOMIZE APPLICABLE VIOLATIONS:] 1. FAILURE TO ACKNOWLEDGE COMMUNICATIONS The insurer failed to respond to my [letters / emails / phone calls] dated [DATES]. [STATE] regulations require insurers to acknowledge communications within [NUMBER] days. [FOR CALIFORNIA: "This violates Cal. Code Regs. tit. 10, § 2695.5(e), which requires acknowledgment within 15 days."] 2. FAILURE TO TIMELY INVESTIGATE OR DECIDE CLAIM More than [NUMBER] days have passed since I filed my claim, and the insurer has not completed its investigation or made a coverage determination. [FOR CALIFORNIA: "This violates Cal. Code Regs. tit. 10, § 2695.7(b), which requires acceptance or denial within 40 days."] 3. FAILURE TO PROVIDE WRITTEN EXPLANATION The insurer denied my claim but failed to provide a clear, written explanation of the reasons for denial and the policy provisions relied upon. [FOR CALIFORNIA: "This violates Cal. Code Regs. tit. 10, § 2695.7(b)(1), which requires a written explanation citing specific policy language."] 4. UNREASONABLE INTERPRETATION OF POLICY The insurer denied my claim based on [STATED REASON], which is an unreasonable interpretation of the policy language. The policy states: "[RELEVANT POLICY LANGUAGE]." 5. FAILURE TO PAY UNDISPUTED AMOUNTS Even though [PORTION OF CLAIM] is not in dispute, the insurer has failed to promptly pay that amount while the disputed portion is being resolved. [FOR CALIFORNIA: "This violates Cal. Code Regs. tit. 10, § 2695.7(h)."] 6. LOWBALL SETTLEMENT OFFER The insurer offered $[AMOUNT OFFERED] when my documented damages are $[ACTUAL AMOUNT]. This offer is not supported by the facts and appears designed to pressure me into accepting less than I am owed. REQUEST FOR ACTION I respectfully request that the Department: 1. Investigate this complaint and [INSURANCE COMPANY NAME]'s claims handling practices; 2. Contact the insurer and request a response to this complaint; 3. Mediate this dispute and assist in reaching a fair resolution; 4. Take appropriate enforcement action if violations are found; 5. Add this complaint to the insurer's record for future reference. ENCLOSED DOCUMENTS I am enclosing the following documents in support of this complaint: 1. Copy of my insurance policy declarations page 2. Copy of the denial letter dated [DATE] 3. Copies of my correspondence with the insurer 4. [REPAIR ESTIMATES / MEDICAL RECORDS / PHOTOS / OTHER DOCUMENTATION] 5. Timeline of all communications I am available to provide additional information as needed. Please contact me at the phone number or email address above. Thank you for your attention to this matter. Sincerely, [YOUR SIGNATURE] [YOUR NAME (printed)] Enclosures: [NUMBER] documents as listed above cc: [INSURANCE COMPANY NAME], Claims Department

What Happens After You File

Acknowledgment

The DOI will acknowledge receipt of your complaint, usually within 1-2 weeks. You'll receive a complaint number for tracking.

Insurer Notification

The DOI sends your complaint to the insurance company and requests a response, typically within 20-30 days.

Review

A DOI analyst reviews both sides and may contact you for additional information or clarification.

Resolution

The DOI issues findings. If violations are found, they may facilitate resolution or take enforcement action. The process typically takes 30-90 days.

Tips for an Effective Complaint

Be Specific and Factual

Stick to facts, dates, and specific regulatory violations. Avoid emotional language or general complaints about the insurer. The DOI needs specific, documented issues to investigate.

Include a Clear Timeline

A chronological timeline of events makes it easy for the investigator to understand what happened. Include all communications, even phone calls (note date, time, who you spoke with, what was discussed).

Cite Specific Regulations

If you can identify specific regulations that were violated, include them. This shows you understand the law and helps the investigator focus their review.

Attach Documentation

Include copies of your policy, denial letters, correspondence, and any evidence supporting your claim. Do not send originals - keep those in a safe place.

⚠️ Limitations of DOI Complaints

While DOI complaints are a valuable tool, understand their limitations:

The DOI cannot force the insurer to pay your claim
A DOI complaint does not pause any legal deadlines (statutes of limitation)
The DOI may find no violation even if you disagree with the claim decision
For significant claims, you may still need to pursue legal action

What to Include vs. Exclude

Include

✓ Complete contact information for yourself and the insurer
✓ Policy and claim numbers
✓ Detailed chronological timeline with specific dates
✓ Specific regulatory violations cited
✓ Copies of all relevant documents
✓ Clear statement of what you want the DOI to do

Exclude

✗ Emotional language or personal attacks
✗ Vague complaints without specific facts
✗ Original documents (send copies only)
✗ Irrelevant information that clutters the complaint
✗ Demands for specific dollar amounts (DOI can't order payment)

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