RAM
Patient Resources
Choosing A Physician
Medical Specialties
Locate a Richmond Doctor
Preparing for an Appointment
During Your Visit
Medical Emergencies
Patient-Physician Relationship
Medical Records and FAQs
Living Wills, Advanced Directives, DNR Orders
Medical Bills: Who to Call
File a Complaint against a Doctor
File a Complaint against an Insurance Company
Medical Care When Uninsured or Uninsured
Protecting our Children
Emergency Preparedness
Nominate a Star
Comments or Concerns
Contact Us



Patient Resources
How to File a Complaint against an Insurance Company

The State Corporation Commission’s Bureau of Insurance (BOI) responds to thousands of individual consumer inquiries and complaints each year. The BOI’s Consumer Service Sections provide free professional information and complaint services to all residents of Virginia. The Consumer Services Sections were created to respond to public inquiries and to assist consumers regarding complaints about services received from insurance companies, managed care health insurance plans, and insurance agents.

If You Have a Complaint Concerning Your Insurance Company or Agent
The BOI encourages consumers to try and resolve any problem with their company, plan or agent before contacting their Consumer Services Section.  If you have any questions or complaints concerning your insurance, many times a mistake has been made, and it will be corrected upon inquiry.

If you contact the company by e-mail or letter, keep copies of all communications.

If you decide to file your complaint by telephone with your company or agent, keep a written record of:

• The date and time of your call
• The name of the person you talked to at the company
• What was said during the call

If Your Complaint Remains Unresolved
You may file a complaint with the BOI as described below under ‘HOW TO FILE A COMPLAINT’ or you may call them first to discuss your concerns.  A Consumer Services Representative will be able to address many of your questions or provide assistance that may help you in resolving your complaint.  If they cannot assist you by telephone, they will advise you on how to file a complaint.

Consumer Services Will

• Thoroughly investigate your complaint;
• Help you get a clear response to your questions;
• Cut through red tape;
• Correct misunderstandings.

Consumer Services Cannot

• Recommend a particular company, agent, or product;
• Recommend or rate an insurance company;
• Provide legal services that are sometimes required to settle complicated problems;
• Make medical decisions or require an insurer to pay for services it has determined was not "medically necessary;"
• Identify an insurance company with whom a particular person may have a policy;
• Dispute an underwriting decision made in accordance with an insurer’s underwriting guidelines;
• Resolve a dispute that is a question of fact;
• Require an insurer to pay a claim.

If they are not able to resolve your problem, they will explain why not.  If the insurance law and facts are on your side, they will try to see that your rights are protected and that your complaint is resolved in a satisfactory manner.

You may file your complaint online at http://www.scc.virginia.gov/division/boi/webpages/boifilecomplaint.htm.

You may submit a written complaint to the Bureau's Consumer Services Section.  Download a complaint form at http://www.scc.virginia.gov/division/boi/webpages/boifilecomplaint.htm.  Send the complaint form, along with the supporting documents to:

State Corporation Commission
Bureau of Insurance
P. O. Box 1157
Richmond, VA 23218

Complaints concerning Life or Health insurance can be faxed to the Bureau at 804.371.9944.

You may reach the Life and Health Consumer Services Section at 804.371.9691 or toll-free number at 1.877.310.6560 to discuss your complaint or receive assistance on how to file a complaint.