Insurance Complaint Process
Other complaint processes and resources:
The Texas Department of Insurance helps consumers resolve complaints against insurance companies, health maintenance organizations (HMOs), insurance agents, and adjusters. Each year, we help thousands of Texans get millions of dollars in additional claim payments and refunds.
Steps to Filing an Insurance Complaint
Step 1: Find out if we can help with your complaint.
We can help with complaints against the insurance companies and people we regulate. We can't help with complaints about service providers, including body shops, building contractors, and doctors. If you have a complaint against a service provider, send it to the licensing or enforcement agency that regulates the provider.
We can help with these types of complaints:
- late or slow payment of claims;
- policy cancellations and nonrenewals;
- improper claim denials;
- health care treatment or service denials;
- poor customer service;
- misrepresentation about what a policy covers;
- discriminatory rate increases;
- false or misleading advertising; and
- suspected insurance fraud.
We can help you with a health insurance complaint if your health plan ID card has “TDI” or “DOI” on it.
We aren’t able to:
- find out who is at fault in an accident;
- settle a dispute with your insurance company when the only evidence is your word; or
- give legal advice or make medical judgments.
If your health plan ID card doesn’t have “TDI” or “DOI” on it, it means your health plan is self-funded. We aren’t able to help with complaints against self-funded health insurance. Learn how to file a complaint with a self-funded health plan.
Call with questions
Step 2: Learn what to do before filing a complaint with us.
There might be other steps you should take before filing a complaint with us.
Call your insurance company
Most insurance companies have a toll-free customer help line. The phone number is printed on your policy. You can also call our Consumer Help Line to get the company’s number and address.
When you call your insurance company:
- have your policy number ready. If you’ve already filed a claim, have your claim number too.
- follow up in writing. Describe your complaint and how you want the company to resolve it.
- send copies (not originals) of letters, notes, invoices, canceled checks, advertising materials, or other documents that support your complaint.
- ask the company to send you a written response.
Issues with your auto or homeowners’ insurance
Most auto and homeowners’ policies have what is called an “appraisal process.” This process is used for resolving disputes about the amount of damages your company will pay. Ask your company if your policy has an appraisal process. You also have the right to appeal the company’s decision or to take the matter to court.
Issues with your health insurance
Most plans have a process for you to appeal if a claim is denied. If you appealed with your health plan and you're still not satisfied, you may be able to have an independent review organization (IRO) review the denial. TDI certifies IROs. If you get an IRO review, the insurance company or HMO must pay for the review and follow the IRO's decision.
Step 3: Gather information.
We will need the following information to look into your complaint:
- your name, address, and daytime phone number;
- the exact name of the insurance company;
- the name of the agents or adjusters involved;
- your policy number;
- your claim number and the date of your loss;
- a copy of both sides of your insurance card, if appropriate;
- a description of your problem;
- what you believe would be a fair resolution of your complaint; and
- copies of all supporting documents, including invoices, canceled checks, advertising materials, and any letters between you and the company or agent.
Learn more about the privacy of the information you send to us.
Step 4: File your complaint.
There are two ways to file your complaint:
- Online form
File your complaint online using our Online Complaint Portal.
- PDF form
Print the form or save it to your computer to complete it. If you save it to your computer, fill out the version you save. You can sign the form by typing your name in the signature fields.
English: Complaint and Authorization Form (PDF)
En Español: Formulario de Queja y Autorización (PDF)
Send the paper form back to us one of these ways:
Mail: Texas Department of Insurance, Consumer Protection, MC 111-1A, P.O. Box 149091, Austin, Texas 78714-9091
In person: Texas Department of Insurance, Consumer Protection (111-1A), 333 Guadalupe St., Austin, Texas 78701
Have a question or need help filing a complaint?
Call our Consumer Help Line at 1-800-252-3439.
Sending documents to support your case
If you use the online form to file your complaint, you can upload your supporting documents or photos through the Online Complaint Portal.
If you use the paper form, you can send supporting documents with the form.
We can accept PDFs, Word, and Excel documents. We also can accept photos in JPG format.
Privacy of the Information You Send Us
To help resolve your complaint, we need to share the information you send us with the person or company named in your complaint. You’ll have to sign a consent form allowing us to share the information. If you don’t sign the consent form, we might not be able to help you.
Also, be aware that some of the information you give us can be given to anyone who requests it under the Texas Public Information Act. We will not give information that is confidential. Medical records, financial information, and email addresses are generally confidential under state and federal law and will not be released.
What to Expect after You File a Complaint
After you file your complaint with us, we’ll contact the company or agent your complaint is against and try to help resolve the dispute.
When we work on your complaint, we will:
- Send you a letter letting you know we’re working on your complaint.
- Tell the company about your complaint and ask for a detailed response.
- Send you a letter with the company's response and an explanation of the outcome. This usually will happen within 60 days after we get your complaint.
- Decide if the company handled your issue within the terms of the policy or certificate of coverage.
- Decide if the company, agent, or adjuster broke state insurance laws. If a law was broken, we’ll take enforcement action.
Deadlines for payment of a claim:
Texas law requires insurance companies to pay claims within a certain time frame. Most licensed insurance companies must:
- Begin investigating your claim within 15 days after getting it.
- Accept or reject your claim in writing within 15 business days after getting all needed information. This deadline may be extended another 15 days after a declared disaster. If the company needs more time, it must tell you why it needs more time. It will then have up to 45 more days to accept or reject your claim.
- Tell you in writing why it denied your claim.
- Pay you within five business days after telling you it will pay your claim.
The laws about paying a claim within a certain time frame don't apply to liability claims against another person’s insurance company. For example, if you’re in a wreck caused by another driver and your claim is against the other driver’s insurance company. These laws also don’t apply to claims involving:
- Self-funded health plans (you have a self-funded health plan if your insurance card doesn’t have “TDI” or “DOI” on it). Learn how to file a complaint with a self-funded health plan.
- Workers’ compensation insurance. Learn how to file a complaint about workers’ compensation.
- Mortgage guaranty or title insurance.
- Fidelity, surety, or guaranty bonds.
- Marine insurance (other than inland marine).
If you’re not satisfied with the outcome:
If you’re not satisfied with the outcome of your complaint, you may discuss your concerns with an attorney.
If your complaint involves an auto or homeowners insurance policy, you may ask for alternative dispute resolution (ADR). ADR uses mediation with a neutral third party to settle disputes outside of court.
If you need help finding an attorney, visit the State Bar of Texas Lawyer Referral and Information Service website or call 1-800-252-9690.
For more information, contact:
Last updated: 02/24/2017