Wednesday, December 1, 2021

How To File A Complaint Against A Dental Insurance Company

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Before Filing A Complaint

How to Destroy Your Dentist in 5 Minutes or Less: A Lesson on HIPAA Complaints

Contact the insurance company or agent and bring the problem to their attention. Document your phone calls by noting the name of the person you speak to, the date of the call and a brief summary of the conversation. Keep copies of all written communications with your insurance company or producer.

If you are not satisfied with the response, contact the Division of Consumer Affairs for assistance. We have staff available to answer general questions at 800-726-7390. You also can file a complaint with our division so we can investigate the situation on your behalf.

Option : Contact An Independent Insurance Ombudservice

There are independent organizations that help consumers resolve disputes or concerns with their insurance company. These services are free of charge, and help address consumer concerns about claims, interpretation of policy coverage, and policy processing and handling. They will mediate between insureds and insurers, but do not have the ability to order settlement of a claim or provide a legal opinion about policy coverage.

For general insurance, such as home, automobile and commercial insurance, contact the General Insurance OmbudService:

Website: www.giocanada.org

For travel, life, accident and sickness, and other private health insurance, contact the OmbudService for Health and Life Insurance:

Website: www.olhi.ca

Take Your Complaint To Arbitration

If youve been formally denied coverage, arbitration may be an option.

Your policy will state how or where disputes will be handled, says Marc Fitapelli, an attorney with the New York law firm Fitapelli & Kurta. There is a growing trend towards arbitration. However, arbitration is only available if the policy explicitly requires it. If the policy is silent, then the parties will have to litigate in court.

There are two types of arbitration: binding and nonbinding.

With non-binding, you can disagree with the arbitrators decision and file a lawsuit, explains Adria Goldman Gross, an advocate with MedWise Insurance Advocacy. Insurance companies usually mandate a binding arbitration on their policiesif they allow any arbitration at all.

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Example: Suing The Other Sides Insurance Company

Recently, one of our clients was hit from the side by a red light runner just outside of Houston. The negligent driver had a minimum insurance policy that did not cover the full cost of damages our client suffered. As a result, his medical bills spiraled, enough that the insurer refused to pay based on the interpretation of their drivers policy.

Thankfully, after suing the insurance company, our top-rated accident lawyers were able to get the insurance company to pay its policy limits so that our client can receive their deserved compensation. Call our Houston car accident lawyers Sutliff & Stout at 713-987-7111 today for your car accident case.

What You Need For Filing An Insurance Complaint

How to file a Complaint against an Insurance Company ...

If your complaint involves ongoing litigation, do not complete this form. Consumer Services is not authorized to render legal opinions and does not intervene between attorneys and their clients, nor do we perform work on behalf of attorneys.

Before submitting your complaint:

Our ability to assist you requires your cooperation. In order to process your complaint, we need the following information from you:

  • Name of the insurance companies and agents involved
  • Your policy and/or claim numbers as well as the names and phone numbers of the people you have been dealing with.

Please be sure to send us all relevant information when you submit your complaint. If you need to send more documents or a longer summary than the form allows, please email the information to CSSComplaints@mass.gov and note that you filed a complaint and are providing additional documentation. Please be aware that Consumer Services will send a copy of your complaint and any related materials to any company, agent or licensee involved in this matter. Please do not send any medical records.

What happens after you submit your complaint?

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File A Consumer Complaint

Consumer complaints against insurance companies must be received in writing. There are 2 ways you may submit a complaint to IDOI. You may file a complaint using our on-line form or you may print off our form and mail or fax to the Consumer Services Division.

Please do not include any Social Security Numbers.

Complaint Process

  • Your complaint is processed within 72 hours of receipt.
  • You will receive a confirmation letter from the Consumer Services Division acknowledging the receipt of your complaint. On this confirmation letter your problem report number is listed along with your Consumer Consultants name that is handling your file. Please refer to this problem report number for any further correspondence to the Division regarding your complaint.
  • Your complaint along with a letter from the IDOI is mailed to the insurance company the complaint is against. By Indiana law, the insurance company has 20 business days to respond in writing back to the IDOI.
  • After receipt of the response, the IDOI will send you a copy of the company’s response along with our response or recommendation.
  • Your complaint will be kept on file at the Department of Insurance and will become a public record.

Option : The Dispute Resolution Process

When you cannot reach an agreement about the following issues, they must be determined using the Dispute Resolution Process set out in section 519 of the Insurance Act .

  • value of the insured property
  • value of the property saved
  • nature and extent of the repairs or replacements required
  • amount of the loss or damage

The dispute resolution process must be used in settling the amount of a loss with your own insurer. Your insurer must send you a copy of section 519 of the Act within 10 days of determining that there is a dispute in respect to the amount of a loss.

Alternatively, as an insured, you can initiate the dispute resolution process in respect to the amount of a loss at any time, using the following process:

  • The umpire will issue a written decision based on information provided by the representatives.
  • The outcome of the dispute resolution process is final and binding for both the insured and the insurer on the issue of the amount of the loss.
  • It is important to note that the dispute resolution cannot be used to resolve contractual disagreements, such as whether there is coverage under the policy. The interpretation of what is covered by your policy is a matter for the courts to decide.
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    This Is What We Can Do:

    • Forward a copy of your complaint to the insurance company, if appropriate:
    • Obtain information or explanations on your behalf from the insurance company or their representatives. This may involve written and verbal contact with such companies or persons
    • Review in detail the information obtained from the company for compliance with statues, regulations and policy contracts
    • Explain the provisions of your insurance policy, as appropriate
    • Suggest to you actions or procedures that you may take which could aid in resolving your insurance problems
    • If it is determined that the actions of an insurance company are in violation of a statute, regulation or policy that the Division enforces we may take corrective action against that company

    Want To Complain About Your Insurance Company Start Here

    How to File a Complaint

    If you bought your policy through an agent, you can enlist that person as an advocate to help with your complaint.

    If you are having difficulty getting payment you are owed or any other trouble, your first line of defense is your local agent, says Corinne Kligmann, a partner at Lift Financial, a financial advisory firm in South Jordan, Utah. Their interests lie with yours, not with those of the insurance company. They can be a great ally and they are by far the easiest way to reach a good outcome.

    If that doesnt work, Kligmann recommends contacting the agents manager. Thats the next step up to navigate the process. If your agent cant help you, there is nearly always a manager to speak to for help. In most cases, it does not need to go any further than this, she says.

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    File A Complaint With State Regulators

    In the U.S., insurance companies are regulated by states, thanks to the McCarran-Ferguson Act, a 1945 federal law that exempts the business of insurance from federal regulation. Check the National Association of Insurance Commissioners website for the appropriate insurance contact in your state .

    State insurance departments are the official complaint-takers for insurance problems.

    They will generally engage in an investigation of the matter, says Dennis Sawan, a personal injury lawyer in Toledo, Ohio. They will also permit the insurer to explain their view of the situation. Upon adjudication, the body will either certify that no insurance law was broken, or if an insurance law was broken, will refer it to the market conduct division for enforcement.

    Complaints to a state insurance department arent guaranteed to work. In Ohio, the department of insurance explicitly says it will not force a company to satisfy you if no laws have been broken, even if you believe the company or agent has not been fair.

    The number of complaints to your states department of insurance is a matter of public record. It shows how many consumers have purchased a policy, how much the policies are written for, and the number of complaints. The department then divides the number of complaints by the policies written and calculates a complaint ratio. The higher the complaint ratio, the worse the insurance company.

    What Types Of Complaints Against Insurance Companies Does The Bbb Handle

    The BBB handles a broad range of complaints against insurance companies. Here are some examples:

    • If your insurance company fails to pay after a car accident.
    • If your insurance company denies a claim in bad faith.
    • If your insurance company does not pay for all costs on a covered claim.
    • The insurance company is overcharging you for the premiums.
    • The insurance company did not reimburse you after you made payments to fix your car.
  • Scroll to the bottom of the page and click the button âStart Your Complaint.â
  • What to Expect Once you Submit your Complaint to the BBB

    • The BBB will forward your complaint to the insurance company within 2 business days.
    • The insurance company will be asked to respond within 14 days, and if a response is not received, a second request will be made.
    • You will be notified of the insurance companyâs response when the BBB receives it .
    • Complaints against insurance companies are usually closed within 30 business days.

    What to do if no agreement is reached after a BBB complaint? You may want to try suing in a California small claims court

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    We will terminate the privileges of any user who uses the Site to unlawfully transmit copyrighted material without a license, express consent, valid defense or fair use exemption to do so. In particular, users who submit user content to the Site, whether articles, images, stories, software or other copyrightable material must ensure that the content they upload does not infringe the copyrights of third parties.

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    Example: Suing Your Insurance Company

    29+ Free Complaint Letter Templates

    While suing the other sides insurance company is common, another example is suing your own insurance company.

    For instance, your home was damaged and now your insurance company refuses to cover the cost. The insurance company may claim that its outside of your policy limits or that they have a different interpretation of your policy. No matter what, they wont help when your home desperately needs repair.

    In this case, filing a lawsuit against your own insurance company is the next step. When filing a lawsuit against your own insurance company, there are various laws that apply to your situation, such as contract law, the Deceptive Trade Practices Act, and other insurance provisions that require fair treatment.

    All lawsuits require evidence to make your claim as convincing as possible. Here the simple steps to follow to increase your chance of success:

    Keep all your receipts related to your expenses. Keep every receipt that relates to your accident. This includes repairs to your property , medical bills, doctors appointments, medical equipment, etc. Anything you purchase related to your claim is important to make a copy of and put in a file.

    Always take pictures. Take pictures whenever possible of your damaged property, repairs, and anything related to your claim that you think may be important.

    Sometimes, it may be necessary or inevitable to file a lawsuit if you cannot resolve your claim fairly through negotiation or through the Texas Department of Insurance.

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    S To Take Before Filing An Insurance Complaint

    There are many legitimate reasons to file a complaint including all of the reasons we mentioned above. However, there are also certain steps you may want to take before filing a complaint.

    These steps can solve your problem and avoid the need to file a complaint. Or, these steps can help your insurance claim get processed and you can still file a complaint.

    First, we recommend speaking with people of authority at your insurance company.

    Make sure your communications are through email so you can keep a detailed record of your attempts and any responses youve received, or havent received. Insurance companies will sometimes deny that they have received communication or spoken with anyone about your concerns.

    There are people at your insurance company who may be able to resolve your claim. You may have had a bad relationship with a specific adjuster who was in a bad mood the day he/she inspected your property, for example. A different adjuster might have a totally different opinion on your claim.

    If you are at all considering hiring a Public Adjuster for an insurance claim, we recommend talking to them before you take any further steps. A good public adjuster can help advise you on your options, assist with filing a complaint, and provide guidance on the next best steps, all with your best interests in mind.

    Before contacting your states insurance commissioner for insurance problems, we recommend speaking with:

    What Is A State Insurance Commissioner

    Its within your rights as a policyholder to make a complaint to your states insurance commissioner.

    Each state has a different insurance commissioner. The state insurance commissioner is a public official who regulates the insurance industry in each state.

    If there is a problem in the insurance industry, then the commissioner is able to investigate the issue and take steps to resolve it.

    Ultimately, the insurance commissioners goal is to enforce the states insurance laws. Many states have laws governing how long insurance companies can take to respond to your claim, for example. Virtually every state has a law requiring insurance companies to pay your claim in a reasonable length of time.

    If your insurance company has broken your states insurance laws, then your states insurance commissioner will want to hear about it.

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    When And Where To Go

    Dentist complaint services come in many forms. You can go to general dental complaints services, but you can also check out independent dental complaints services that offer assistance in seeking compensation or resolution for certain problems encountered during a dental procedure.

    There are many possible instances when dental patients can file a dentist complaint. If you feel unsatisfied about the treatment you received, or your dentist did not carry out the complete service as agreed upon, you can use this as grounds for the complaint.

    You may also complain about the dentist, dental hygienists, or even dental assistants as long as you have a valid complaint to make.

    Copyright dentalinsurancecare.com. Protected by Copyscape – do not copy.

    File A Complaint With The Texas Department Of Insurance

    Complaint Letter–How to Write an Effective Letter/Email of Complaint

    The first, and most common, way to file a complaint with an insurance company is to submit a complaint with the Texas Department of Insurance . The TDI was created to help protect consumers from dishonest and unethical insurance companies and practices. They regulate all insurances written in Texas and is tasked with overseeing the industry in general.

    While they cant fix all complaints, they respond to many auto, homeowner, life, health, and title insurance complaints.

    To file a complaint against an insurance company in Texas, visit their website and fill out their form.

    TDI also gives you the option of printing out their complaint form, filling it out, and mailing it to them yourself at:

    MC 111-1A

    Before you fill out the TDI complaint form, make sure you have the following information:\

    • Your insurance policy number
    • A copy of your insurance card
    • The name of the insurance agents or adjusters involved in your case
    • Your claim number and the date of your accident or loss
    • A detailed description of your problem
    • What you think is a fair resolution if your complaint
    • Copies of all the materials that support your complaint

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    What Is The California Department Of Insurance

    The California Department of Insurance is a government agency that regulates insurance companies operating in California.

    They issue insurance licenses, investigate consumer complaints, and enforce the rules that insurance companies have to follow.

    Don’t forget to always review insurance company complaints before purchasing insurance!

    Contact Your Insurance Company To Resolve The Complaint

    Before reaching out to the Consumer Services Division about your dispute, contact your insurance company and ask them to resolve the issue.

  • State your complaint to the companys representative
  • Ask them what you need to do to submit your dispute
  • Keep meticulous records of all your communications with the insurance company regarding your dispute. When calling, note the phone number you called, the name of the person you spoke with, the date of the call, and write a brief summary of the conversation. Keep copies of all correspondence between you and the insurance company regarding the complaint, including all emails you send and receive.
  • Gather and send all of the required documentation to the address provided by your insurance company. Note: you should send copies of all your personal supporting documentation, such as invoices, notes, canceled checks, notices, etc.
  • If you are unable to resolve your dispute with the insurance company or arent satisfied with how they respond to your claim, move to Step 3.

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