Sometimes policyholders file a complaint against their insurance company with their state insurance regulatory agency in hopes that it will help resolve their claim.  Because we frequently represent the interests of policyholders against insurance carriers that fail to fulfill the terms of their policies, we recognize that a complaint to your state’s insurance regulatory agency can have benefits.  However, this remedy also has significant limitations.

Every state has an agency that is charged with regulating the insurance industry.  The entity charged with this task in our state is the Office of Financial Regulation Division of Consumer Services.  While complaints typically must be filed in writing by completion of a standard form or submission of a letter in most states, Florida permits such filings by telephone, email, or online. 

When filing a complaint with Florida insurance regulators, policyholders should have the following information available:

  • Date the incident causing loss or accident occurred
  • Names of any parties and persons involved
  • General description of the claim 
  • Itemization of communications in writing and over the phone with the adjuster and supervisors in an attempt to resolve the claim
  • The insured’s contact information: name, address, email, and telephone numbers
  • Insurance policy information: name of insurer, policy number, and claim number
  • Copies of all relevant documents and correspondence related to the claim
  • Clear description of the issues or problems (e.g., unfair settlement tactics, unjustified denials, inadequate investigation of the claim, lack of communication or response from the insurer, failure to provide a reasonable settlement offer)

The nature and speed of the response by state insurance regulators varies substantially between states.  In a number of states, every complaint is given at least some amount of attention.  There also are many states where regulators only take action when the offending party has engaged in particularly egregious conduct or has been the subject of multiple complaints.

There are a range of situations where an insured might benefit from filing a complaint with the state insurance regulatory agency.  Examples of conduct by an insurance adjuster that might merit a complaint include the following:

  • Perfunctory or delayed settlement offers
  • Refusal to offer any settlement of the claim
  • Misleading or false information from the adjuster or supervisors
  • Use of pressure tactics or other unethical conduct

However, a complaint generally will not be given much consideration if the insurer made a settlement offer but the parties dispute the value of the claim.

The mere threat that you might file a complaint with state insurance regulators can yield benefits if the claims process is stalled.  In the best case scenario, the specter of a governmental complaint might bring a settlement offer.  Admittedly, state insurance regulators do not pursue a high percentage of complaints by individual policyholders.  However, insurance companies and adjusters would prefer not to have such complaints because multiple complaints might result in an inquiry into the adjuster or carrier.  When the insurer receives notice of the complaint, this communication also might promote progress because representatives of the insurer beyond the adjuster will be made aware of the situation.

You can reach Miami Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].

J.P. Gonzalez-Sirgo
J.P. Gonzalez-Sirgo, P.A.
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