The primary role of the IDOI Consumer Services Department is to protect consumers from illegal insurance practices by ensuring that insurance companies and producers that operate in Indiana act in accordance with State insurance laws. We are here to assist you with your insurance inquiry or complaint about health, life, automobile, and property and casualty insurance.
Example of the types of problems that you may submit to the Department:
- Improper denial or delay in settlement of a claim
- Alleged illegal cancellation or termination of an insurance policy
- Alleged misrepresentation by an agent broker or solicitor
- Alleged theft of premiums paid to an agent, broker, or solicitor
- Problems concerning insurance premiums and rates
- Alleged improper handling of an insurance claim by a company or agent
Back to Top
This is what we CAN do:
- Forward a copy of your complaint to the insurance company, if appropriate:
- Obtain information or explanations on your behalf from the insurance company or their representatives. This may involve written and verbal contact with such companies or persons;
- Review in detail the information obtained from the company for compliance with statues, regulations and policy contracts;
- Explain the provisions of your insurance policy, as appropriate
- Suggest to you actions or procedures that you may take which could aid in resolving your insurance problems
- If it is determined that the actions of an insurance company are in violation of a statute, regulation or policy that the Division enforces we may take corrective action against that company
Back to Top
This is what we CAN NOT do:
- Assume the role as your legal representative in or out of court
- Intervene in a pending lawsuit on your behalf
- In the case of disability insurance complaints, make a medical decision as to the extent of an individual's disability. We investigate complaints involving disability insurance to determine (1) whether or not the denial decision is arbitrary or capricious and (2) whether or not the denial decision was rendered in accordance with the terms of the insurance contract and State insurance laws and regulations
- Address complaints or inquiries involving insurance contracts that are not subject to the jurisdiction of the insurance laws of the State or matters governed by other State or Federal agencies. This would include the following:
Before you file a complaint with the IDOI you should first contact the insurance company, agent or broker in an effort to resolve the issue(s). If you do not receive a satisfactory response, then you may file a complaint with the Division. When filing a complaint please provide as much information as possible. Failure to provide this information may delay or even prevent our ability to be of assistance. Please be aware that a copy of your Complaint will be provided to the insurance company.
In order for us to effectively begin our investigation you will need to provide supporting documentation with your complaint. Failure to provide supporting documentation may delay your request. Supporting documentation includes any documents (copies) related to your problems, such as the declaration page of your insurance policy or certificate, cancelled checks, letters of claim denial or other correspondence. Do not send us originals of any documents, photographs or other evidence as we are not responsible for lost records or other items. The more complete the information we receive, the quicker we can identify the issues and begin our review.
Back to Top
To help avoid problems getting claims paid, the Indiana Department of Insurance offers these tips:
- Know Your Policy -Understand what your policy says. The policy is a contract between you and your insurance company. Know what's covered, what's excluded and what the deductibles are.
- File Claims as Soon as Possible - Don't let the bills or receipts pile up. Call your agent or your company's claims hotline as soon as possible. Your policy might require that you make the notification within a certain time frame.
- Provide Complete, Correct Information - Be certain to give your insurance company all the information they need. Incorrect or incomplete information will only cause a delay in processing your claim.
- Keep Copies of all Correspondence - Whenever you communicate with your insurance company, be sure to keep copies and records of all correspondence. Write down information about your telephone and in-person contacts, including the date, name and title of the person you spoke with and what was said. Also, keep a record of your time and expenses.
- Ask Questions - If there is a disagreement about the claim settlement, ask the company for the specific language in the policy that is in the question. Find out if the disagreement is because you and the insurance company interpret your policy differently. If this disagreement results in a claim denial, make sure you obtain a written letter explaining the reason for the denial and the specific policy language under which the claim is being denied.
- Don't Rush into a Settlement - If the first offer made by an insurance company does not meet your expectations, be prepared to negotiate to get a fair settlement. If you have any questions regarding the fairness of your settlement, seek professional advice.
- Auto and Homeowners Claims- Temporary v. Permanent Repairs - Auto and homeowners policies might require you to make temporary repairs to protect your property from further damage. Your policy should cover the cost of these temporary repairs, so keep all receipts. Also, keep any damaged personal property for the adjuster to inspect. If possible, take photographs or video of the damage before making temporary repairs. It may be helpful to have a video inventory of your property and contents for future reference should you need to file a claim. Don't make permanent repairs prior to the insurance company's inspection. An insurance company may deny a claim if you make permanent repairs before the damage is inspected.
Other Tips for Filing Auto or Homeowners Claims:
- If possible, determine what it will cost to repair your property before you meet with the claims adjuster.
- Provide the claims adjuster with records of any improvements you made to your property.
- Ask the claims adjuster for an itemized explanation of the claim settlement offer.
- Accident and Health Claims - Ask your physician to provide your insurance company with details about your treatment, medical conditions and prognosis. If you suspect a provider is overcharging, ask the insurance company to audit the bill and verify whether the provider used the proper billing procedure.
- For more information about auto, home and health insurance options, and tips for choosing the coverage that is right for you and your family, go to http://www.insureuonline.org/.
CONSUMER WARNING - While Indiana law outlines specific allowable reasons for cancellation of homeowners policies, there are no such protections in place that require insurance companies to offer renewal of the homeowners policy once the contract is over. Insurance companies are allowed to consider claims activity and use that information in determining whether or not to renew your policy. The number of claims or dollar amount of claims may vary across carriers. For example, a carrier may choose not to renew when two claims have been made within a certain time period. Consumers should be aware that the number of claims submitted, including claims for relatively small dollar amounts, may be considered by their insurance company when determining if a renewal offer will be made.
Back to Top
Jurisdiction of IDOI
The IDOI has the authority to regulate (i.e. license, review rates and policies, review financial statements, investigate complaints, conduct examinations and issue orders/penalties) all insurance companies, producers, premium finance companies, motor clubs and HMO's that are licensed to conduct business in Indiana.
Generally, Indiana law does not apply to insurance contracts (or policies) issued in other states. For example, if your policy was issued in Ohio, then Ohio law and not Indiana law applies to your coverage. In these instances, you will need to contact the Regulator in that state for assistance.
In addition, employer self-funded plans also fall outside of the agency's jurisdiction. Self-funded plans are those where your employer pays for your medical expenses, rather than contracting with a health plan to do so. The U.S. Division of Labor regulates self-funded plans, and therefore, has the authority to investigate and resolve complaints against such plans.
The IDOI does not have jurisdiction over federal programs such as the Federal Employee Health Benefit Program (FEHBP), Medicare, Medicaid, HIP, Workers Compensation and Social Security. Please contact the appropriate regulatory authority for additional information on these programs.
Back to Top
- Your complaint is processed within 72 hours of receipt.
- You will receive a confirmation letter from the Consumer Services Division acknowledging the receipt of your complaint. On this confirmation letter your problem report number is listed along with your Consumer Consultants name that is handling your file. Please refer to this Problem Report number for any further correspondence to the Division regarding your complaint.
- Your complaint along with a letter from the IDOI is mailed to the insurance company the complaint is against. By Indiana law, the insurance company has 20 business days to respond in writing back to the IDOI.
- After receipt of the response, the IDOI will send you a copy of the company's response along with our response or recommendation.
File a Consumer Complaint
File a Provider Complaint
Back to Top
To regulate the insurance industry and cut down on fraudulent activity the IDOI and the NAIC ask that any suspected fraudulent activity regarding insurance brokers, insurance companies, or insurance plans be reported
- If you have been a victim or have witnessed fraud please contact the NAIC.
- For other types of fraud please contact National Fraud Information at 800-835-6422
For information regarding fraudulent insurance activity, please contact:
Deputy Commissioner Enforcement Division
Beware of Fraudulent Insurance
Back to Top
- Life and Annuities
- Accident and Health
- Variable Life and Annuities (Segregated Accounts)
- Accident and health - Disability
- Workers Compensation
- Burglary, Theft
- Broiler and Machinery
- Fidelity & Surety with Bail bonds
- Fidelity & Surety with out Bail bonds
- Legal Expenses
- Fire, Windstorm, Hail, Loot, Riot
Back to Top