The State Corporation Commission’s Bureau of Insurance (the Bureau) assists thousands of consumers each year by responding to inquiries and complaints about services received from their insurance companies and agents. The Bureau also assists consumers who want help appealing a denial by their managed care health insurance plan, or who want help requesting an independent external review of a denied health insurance claim. The Bureau’s Consumer Services Sections provide free professional information and services to Virginia consumers.

Are You Experiencing a Problem with Your Insurance Company or Agent?

Is Your Problem Still Unresolved After Contacting Your Insurance Company or Agent?

What Can Consumer Services Do?

What Can Consumer Services Not Do?

What Are Some Types of Plans the Bureau does not Regulate?

What Are My Rights?

How Do I File a Complaint?

How Soon Should I Expect a Response from the Bureau of Insurance?

What Contact will be made with the Insurance Agent or Company?

How Long Will the Investigation Take?

Should I call to check on the Investigation’s Progress?

Are You Experiencing a Problem with Your Insurance Company or Agent?

The Bureau encourages consumers to try to resolve any problem with their company, plan or agent before contacting the Consumer Services Section. Many times a mistake has been made, and is easy to correct upon inquiry.

Always keep a photocopy of your letter for your records. Keep copies of all e-mail or fax communications as well.

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, and
• What was said during the call

Is Your Problem Still Unresolved After Contacting Your Insurance Company or Agent?

You may file a complaint with the BOI as described below under How Do I File A Complaint, or you may call us 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 we cannot assist you by telephone, we will advise you on how to file a complaint.

What Can Consumer Services Do?

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

What Can Consumer Services Not Do?

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

What Are Some Types of Plans the Bureau does not Regulate?

• Self-insured employer plans and health and welfare benefit plans (www.dol.gov/ebsa)
• Medicare (www.Medicare.gov)
• Federal employee plans (www.opm.gov)
• Commonwealth of Virginia employee benefit plan (www.dhrm.virginia.gov)
• Military Insurance plans (e.g. Tricare, etc.) (www.tricare.mil)
• Medicaid (www.dmas.virginia.gov)
• Workers' Compensation Claims (www.vwc.state.va.us)
• Pre-Existing Condition Insurance Plan (www.pciplan.com)

What Are My Rights?

Insurance Companies:

• are not allowed to unfairly discriminate as to premium rates charged or kinds of coverage,
• are required to pay claims promptly and fairly, and
• must give the consumer access to certain information collected by the insurance company.

How Do I File a Complaint?

To thoroughly review your concerns, we ask that you provide as much detail as possible when you submit your complaint. You may mail or fax your complaint. Please attach copies of all supporting documentation to the completed complaint form. Be sure to keep your original documents for your records.

• Fax Information: The Life and Health Consumer Services fax number is (804) 371-9944.
  The Property and Casualty Consumer Services fax number is (804) 371-9349.
• Mailing Address: State Corporation Commission, Virginia Bureau of Insurance, P.O. Box 1157, Richmond, VA 23218.
• Street Address: State Corporation Commission, Virginia Bureau of Insurance, 1300 East Main Street, Richmond, VA 23219.

To ensure you have provided us with the necessary information to review your complaint, you may complete, print, and mail the form below, along with the supporting documents. If you wish to discuss your complaint or receive assistance on how to file a complaint, you can call our toll-free number, 1-877-310-6560, or contact the section directly. You may reach our Life and Health Consumer Services Section at (804) 371-9691 or the Property and Casualty Consumer Services Section at (804) 371-9185.

The forms below are available in Acrobat portable document format (PDF). You may complete the forms using your computer before printing. Use your TAB key to navigate through the forms.

Life and Health Insurance Complaint Form
Formulario de Queja por Seguro de Vida y Seguro de Salud

Health Insurance Premium Inquiry Form

Property and Casualty Insurance Complaint Form

Ethics and Fairness Complaint Form

NOTE TO HEALTH CARE PROVIDERS: If you are submitting a complaint on behalf of a particular patient, you must obtain the insured's authorization in order for our office to contact the insurance company on his or her behalf. If you are experiencing problems with an insurance company which are more general in nature, or which involve a number of patients and/or claims, please call our office before submitting the complaint.

When you submit a written complaint, please be sure to provide us with the information listed below. This will allow us to handle your complaint much quicker.

• Your name, address, and the name of the insured person (if different)
• The name and address of the insurance company and/or the agent/agency
• Policy or group certificate number, if applicable
• Claim number and date of injury or loss
• Type of insurance
• A detailed explanation of your problem (i.e. what happened, who was involved, and why you think the company or agent is wrong)
• How you tried to resolve the problem
• What you think the company or agent should do (pay a claim, make a refund, etc.) to resolve your problem

How Soon Should I Expect a Response from the Bureau of Insurance?

Within a week after we receive your written complaint, we will assign a file number and send you a letter acknowledging receipt of your complaint.

What Contact will be made with the Insurance Agent or Company?

In most cases, a letter and a copy of your complaint will be sent to the company or agent, requesting an explanation of its position. Telephone contact may be made to discuss the complaint, to ask questions, or to make specific requests. After the company or agent responds, we will determine what further actions, if any, we will take.

How Long Will the Investigation Take?

Normally, it takes about 45 days after we receive a complaint to provide our written response. However, it may take longer if your complaint is claim related, or involves a unique or complex problem, or requires the insurer or agent to conduct extensive research.

Should I call to check on the Investigation’s Progress?

You do not need to call. We will keep you informed and advise you of the outcome of our review.

If you have additional information, send it to us in writing. (Include the file number we assigned in our letter of acknowledgment, and send it to the person investigating your complaint.)