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Want to File a Complaint?

CONSUMER SERVICES

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 General Question about Insurance

Consumer Service Representatives can handle your inquiries over the telephone. They can be reached Monday through Friday, 8:15AM to 5PM at our toll free number 1-877-310-6560, or our direct number at 1-804-371-9691 (Life and Health Insurance) and 1-804-371-9185 (Property & Casualty Insurance). If we cannot assist you by telephone, we will advise you to file a written complaint or inquiry with the BOI. We will provide you with a written response to your written complaint or inquiry.

If you have a general question you may wish to e-mail us at bureauofinsurance@scc.virginia.gov. A Bureau Representative will respond to your inquiry via e-mail. Please include your name, mailing address and telephone number, in addition to your questions and concerns.

 

If You Have A Complaint Concerning Your Insurance Company Or Agent

The BOI encourages consumers to try and resolve any problem with their company or agent before contacting the 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.

Always keep a photocopy of your letter. 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 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.

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 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.

 

Examples of Complaints that the Bureau of Insurance Handles

The Bureau of Insurance handles insurance complaints involving auto, home, liability, managed care health insurance plans, health, dental, life, annuities, credit, etc. Examples of complaints may include claim disputes, questions pertaining to your premium, coverage questions, misleading advertising, sales misrepresentations, and policy cancellations.

 

Examples of plans that the Virginia Bureau of Insurance does not have Jurisdiction Over

  • Self-insured employer plans and health & welfare benefit plans
  • Medicare
  • Federal employee plans
  • State of Virginia employee benefit plan
  • Military Insurance plans (e.g. Tricare, etc.)
  • Medicaid
  • Workers’ Compensation Claims

 

Know Your Rights

  • Insurance companies are not allowed to unfairly discriminate as to premium rates charged or kinds of coverage available to consumers.
  • Insurance companies are required to pay claims promptly and fairly.
  • Consumers have a right to access certain information collected by insurance companies.

 

How to 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 1-804-371-9944.  The Property and Casualty Consumer Services fax number is 1-804-371-9349. 

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 sections 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). Acrobat Reader is required to view PDF files. You may download it by clicking the "Get Acrobat Reader" button. You may complete the forms using your computer before printing. Use your TAB key to navigate through the forms.

Life and Health Insurance Complaint/Appeal 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 receiving 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 from the time we receive a complaint until we can provide our written response. However, it may take longer if your complaint is claim related, or involves a unique or complex problem, or if the insurer or agent must conduct extensive research before responding.

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

  • If you would like to provide additional information, you can fax or mail this information to us. Be sure that you include your complaint identification number. We will keep you informed on the status of your complaint.

 

 

 

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  • Street Address: Tyler Building, 1300 E. Main St., Richmond, Virginia 23219
  • Mailing Address: P.O. Box 1157 Richmond, Virginia 23218
  • Toll Free Phone: (Virginia Only) 1-800-552-7945 * TDD Phone: 804-371-9206
  • Ombudsman and Consumer Service Hotline Toll Free Phone: (Nationwide) 1-877-310-6560
  • BOI Main Phone: 804-371-9741*Agents Licensing Phone: 804-371-9631
  • Need additional information? Contact: bureauofinsurance@scc.virginia.gov
  • Website questions? Contact:mailto:webmaster@scc.virginia.gov