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IDOI > Consumers > Complaints Complaints

The Department accepts complaints and compiles reports so you and other members of the public can evaluate the companies and agents who conduct insurance business in Indiana. Once the complaint information has been collected, we thoroughly investigate all circumstances and take any appropriate action to prosecute or fine the company or person if found to be at fault.

For information regarding current enforcement actions, please contact:

Nick Mann
Chief of Investigations for Enforcement
317-233-9431
nmann@idoi.in.gov

Filing a Consumer Complaint

If the insurance company has not followed the terms and conditions of your policy, you may submit a consumer complaint form.  Examples of appropriate issues include:

  • Coverage Concerns
  • Claim Disputes
  • Premium Issues
  • Policy Cancellations
  • Refunds

You may submit a consumer complaint online or via the mail. 

Submit a complaint online

Download and print a complaint form

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Filing a Provider Complaint

If insurance companies fail to provide prompt payments to health care providers, the provider can file a complaint against that company. Potential payment complaints include:

  • Non-payment
  • Continuous late payment of claims
  • Down-coding of claims without notice
  • Payment of non-network providers at network provider fee instead of usual and customary rate

As with any consumer complaint, we thoroughly investigate the issue and advise whether the company has acted appropriately or inappropriately within the confines of law. 

How to File a Complaint

In order to efficiently address your concerns, please follow these guidelines.

  • File a separate complaint for each patient involved
  • All complaints should include the name and address of the insurance company, policy information including the patient’s name and group or policy number, and a description of the problem

Download and print a Complaint Form.

Restrictions

The Department handles various types of complaints, but certain ones are outside our area of jurisdiction and become the responsibility of other state or federal agencies such as:

  • If the company is not licensed to do business in Indiana; please direct complaints to the Department of Insurance in the state where the company is licensed.
  • If the claim involves Worker's Compensation, please direct your complaint to the: Worker's Compensation Board, 402 W. Washington St., Rm. W196, Indianapolis,  Indiana 46204.
  • If the group health plan is ‘self-funded’ rather than ‘fully insured’, only the federal government regulates it.  This distinction refers to what entity has the financial risk for paying the medical claims. This cannot be determined by the information on your ID card or certificate of coverage.  You will need to ask the employer that sponsors the group plan which type of plan it is. About 70% of Hoosiers with group health insurance are covered under self-funded plans.

Complaint Form Follow-Up

We will assign a case number when the complaint is received and send you an acknowledgement letter.  Please refer to the case number if you contact us about the case.

For information regarding a complaint, please call 1-800-622-4461.

If you have already filed a complaint, please contact the Consumer Consultant whose name and contact information appear on your communications.

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Report Fraud

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 information regarding fraudulent activity, please contact:

Carol Mihalik
Chief Deputy Commissioner for Enforcement
317-232-1990
cmihalik@idoi.in.gov

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Consumer Complaint Index

The Complaint Index Ratio Table shows consumer complaints filed with the Department of Insurance from 2001 – 2004.  The index is weighted by premiums received from the insurance company.

The Complaint Index Ratio Table provides information including:

  • Health Carriers
  • Life Carriers
  • Annuity Carriers
  • Auto Carriers
  • Homeowner Carriers

The table uses the amount of each company’s premium and the number of closed complaints against the insurer during a calendar year to arrive at a complaint index.

  • An index of 0.50 means that the insurer’s share of complaints is half as large as its share of business
  • An index of 1.00 means the insurer’s share of all complaints received is equal to its share of all the business written in Indiana.
  • An index of 2.00 means that the insurer’s share of complaints is twice as large as its share of business written in Indiana

Important factors to keep in mind when looking at the complaint index include:

  • Cost of the insurance
  • Services provided by your agent
  • Company’s claims processing services
  • Financial stability of the company

Access the Company Complaint Index

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Enforcement Actions

View a list of enforcement actions