Many us have been there before. You’ve been in a car accident (or other type of incident). Perhaps you can’t get in touch with the insurance company. Or maybe they are only offering to settle for $100,000 when your motorcycle accident case is worth $445,000. Who do you complain to about an insurance company? How do you file a complaint?
Here, I am going to answer these questions and much more.
As a personal injury lawyer with 16 years experience, I’ve dealt with about 50 different insurance companies and somewhere around 1,000 claim adjusters. This includes long term disability insurers, health insurance companies, business liability insurers, auto insurers and more. Many of them are responsive. Some were even fair. For instance, CNA settled an Uber accident case with me for $260,000.
However, not all adjusters or insurance companies are reasonable. Thus, I have had to file my fair share of complaints with the department of financial regulation.
One of your options is to file a consumer complaint. It is also known as a “request for insurance assistance.” This is different than filing a civil remedy notice of insurer violation. A civil remedy notice is typically used in order to get damages above the policy limit. A consumer complaint is also different from suing in court.
This article applies to consumer complaints for claim arising from accidents in Florida. It applies to claims for:
- Car accidents and truck crashes
- Motorcycle accidents
- Bike Accidents
- Moped or scooter accidents
- Getting hit by a car while a pedestrian
- Bus accidents
- Accidents at a premises, like a slip and fall, trip and fall
- Being electrocuted at a premises
- Many other accidents
- Property damage from a car crash or other type of accident
A TPA claims manager at Wal-Mart Stores, Inc. says that:
Surveys of … adjusters’ show that even at a caseload of 130 files adjusters consider themselves in a reactive mode being overwhelmed with phone calls data entry and email requests.
TPA means “third party administrator”. A TPA is used when a company outsources it claims handling to another company.
Most insurance companies give their adjusters too many claims to handle. Thus, adjusters don’t have time to give your case the attention that it deserves.
Sometimes adjusters will miss an important fact in your case. This may result in them making a lower offer, or no offer at all.
Who Can’t You File a Consumer Complaint Against?
You typically can’t file a consumer complaint if your making a claim against a company that is self-insured. This assumes that your claim is worth less than their self-insured retention (SIR). Large multi-billion dollar companies are typically self-insured. However, the SIR is only up to a certain amount.
Even the biggest companies in the United States only self insure up to a certain amount. They won’t run the risk of bankruptcy should they have a catastrophic loss.
Examples of claims against a large company that may be self-insured is:
- Publix Supermarket Injury Claims
- Carnival Cruise Slip and Fall Accident Claims
- Royal Caribbean Cruise Lines
- Norwegian Cruise Lines
- Accidents at Disney World
- Accidents at Walmart
- Slip and Falls at Winn Dixie
- Injury and Accidents at a hotel, resort or motel that is owned by a big corporation
But again, those companies are self-insured up to a certain limit.
When can you file a consumer complaint against an insurance company?
If you’re hurt in a car accident in Florida, you will most often be dealing with a Florida car insurance policy. Thus, the consumer complaint is typically filed with the Florida Department of Insurance.
When should you file a consumer complaint in another state (for a Florida accident)?
Even though the accident happened in Florida, you’ll likely have to file a consumer complaint with another state’s department of insurance if you’re making a claim:
- with an insurance company based on an out of state uninsured motorist (“UM”) policy
- against a driver who has car insurance from another state.
Example
You own a car, with UM insurance on it, in Georgia. While in Florida, another car hits you.
You make a claim against your Georgia UM insurer. If your Georgia UM insurer isn’t being fair, you need to file the consumer complaint in Georgia. You don’t file it in Florida.
(Here is a link to filing a consumer complaint against a Connecticut insurance company.)
How Do Consumer Complaints Apply to Personal Injury Cases?
If the insurance company does one of the following, you may want to consider making a consumer complaint:
- Not answering the phone or returning your phone calls, emails or faxes about your injury claim. In certain situations, it may be reasonable to give the adjuster three (3) days to respond to your call.
- Not making a settlement or not making a fair settlement offer.
- Not agreeing to reduce a claimed lien for short or long term disability (LTD) benefits paid to the injured person despite the requirement to do so in Florida Statute 768.76 (4). Look at this sample consumer complaint when a disability insurer won’t reduce your lien.
How Do Consumer Complaints Work For Car Accident Claims?
- Not responding to your letter, email or fax requesting insurance information of the negligent driver as required by Florida Statute 627.4137.
- Refusing to pay your health insurance, Medicare, Medicaid, or other first party coverage lien with PIP benefits to which you are an insured.
- The PIP insurer to which you are an insured is not paying your lost wages even after you have sent them a completed wage and salary verification form.
- The PIP insurer to which you are an insured is not paying your hospital bill.
- The negligent party’s auto insurance company may be delaying or refusing to pay for your rental car. (Note: I only help my clients with rental car claims if they also have a personal injury case.)
- The PIP insurer to which you are an insured is not paying your medical bills a Statement-of-Vehicle-Non-Ownership.
What Are Reasons to File a Consumer Complaint in a Slip and Fall?
- Not properly responding to your written request for insurance information of the property owner or manager as required by Florida Statute 627.4137.
- Not issuing you a check for your medical bills/expenses if you were injured on someone else’s property and the property owner has “medical payments” coverage.
I have filed a consumer complaint (also known as a “request for insurance assistance”) in Florida in all of the above situations. The insurance company became more reasonable in handling the claim in most, if not all, of the above situations.
Do Insurance Companies Take Your Case More Seriously If You File a Complaint?
The good news is that filing a consumer complaint may result in the insurance company (or TPA) taking your injury claim much more seriously.
I spoke to a State Farm adjuster, in a case that I settled with them for $125,000, and he told me that he only gets about 1 consumer complaint for every 250 to 500 cases that he handles, and possibly less often than that.
That settlement was before deduction for attorney’s fees and expenses. Most cases result in a lower recovery. It should not be assumed that your case will have as beneficial a result.
Getting the Claims Manager to Look at Your Claim May Be Good
The fact that consumer complaint will trigger a review by the insurer’s claims manager is good news for you. Since consumer complaints are rarely filed, this acts in your favor because your complaint will stand out to the adjuster and the claims manager.
I talk about how to file a consumer complaint below. Once you file it, the insurance company must respond within 20 days of receiving the complaint.
Does an insurance company gets fined if they don’t answer the complaint?
Their response must address the issues and allegations raised in the complaint or they may be fined $2,500 in addition to the individual licensed by the department of insurance who may be fined anywhere from $250 to $1,000.
The law (statute) that talks about this is s.20.121(2)(h)(2), Florida Statutes. This penalty makes the insurance company highly likely to respond to your complaint.
Basically, the insurance company will have to give a legitimate response to the Florida Office of Insurance Regulation as to why they are handling your claim a particular way.
Warning: I’ve heard a former State Farm claims adjuster say that he would not file a consumer complaint against an insurance company. He believes that it ticks the adjuster off.
My goal is not to scare an insurance adjuster. Rather, I just want my client’s personal injury case to get the attention that it deserves.
In my view, getting the adjuster’s (or her manager’s) attention is better than no response at all.
How do I file a complaint with the Florida Department of Insurance?
To file a complaint, you can go to submit a request for insurance assistance and file a complaint with the Florida Department of Financial Services.
You will be taken to a page that looks like this:
Click the next button.
Warning: This consumer complaint and its attachments will be public record so do not attach any medical records or other documentation that reveals your social security number or sensitive health information.
The steps to file a complaint are as follows:
1. Provide your name and email address.
2. Enter the type of insurance.
If you were in a car accident, you should enter “personal automobile” or “accident & health.” If you were in any other type of accident, you should enter “accident & health.”
3. Enter the county in Florida that the accident took place in.
You need to enter a policy number. If your own Florida insurance company isn’t responding to you, enter your policy number.
Your car insurance card should have your policy number on it. Each time you are mailed a letter from your auto insurance company it should have your policy number on it.
You can also call your insurance agent to get your policy number. If it the person’s (who caused your accident) Florida insurance company, you can enter “unknown” or “0.”
4. Enter claim number.
You can locate a claim number by referring to any letters that you may have received from the insurance company.
If you called to report your claim, you should have received a claim number from the insurance adjuster for the insurance company.
If you don’t have a claim number, just type “unknown” or “0000.”
5. Describe your problem.
In the section where it tells you to describe your problem I normally just write “Please see attached” and I upload a letter explaining the issues that I am facing.
I use a general template for these complaints based upon the basis for the complaint. This saves me time. This is a consumer complaint that I filed against a PIP insurer, Windhaven Insurance, when they:
a. were not responding to my calls, emails or faxes.
b. did not send me the written requested required insurance information as required by Florida Statute 627.4137. Thus, I did not know whether PIP, Medical Payments coverage and/or uninsured motorist coverage was available.
c. were not paying my client’s hospital bill.
6. Click the submit button.
Tip: We also send (via email, fax and mail) a copy of the consumer complaint to the insurance adjuster and the insurance company so that they know about it as soon as it is filed.
7. Receive email confirmation
Shortly after completing this request you should receive an email confirmation from the Florida Department of Financial Services stating your request has been received and you should receive a file number (should be a hyperlink) for your request.
You can click on that file number at any time to review the status of your request.
The insurance company has 20 days to respond to your request, and the Florida Department of Financial Services asks for 30 days to review the file and respond to your request.
Do Insurance Companies Usually Respond to a Consumer Complaint?
Yes. Most insurance companies will call you, or send you a letter, within 20 days after receiving your consumer complaint.
You should receive a letter summarizing the position of the insurance company within 30 days from the Florida Department.
I have filed a consumer complaint before against the following insurers:
Crum and Forster
Nautilus Insurance Company
Prudential
- United Auto
- Windhaven Insurance Company
- and other Florida insurers.
I wish that I did not have to file a consumer complaint as it takes time. Unfortunately, it is sometimes the only way (short of a lawsuit) to get an insurance company’s attention if they act in bad faith.
Does a Consumer Complaint Work Better Than a Lawsuit?
It depends. If you just want the responsible party’s bodily injury (“BI”) insurance limits you may be better off filing a consumer complaint than a lawsuit. This assumes that your case is worth much more than the BI limits.
If a consumer complaint doesn’t get the insurance company to act fairly, then you may need to sue. Unfortunately, many insurance companies don’t take a case seriously until there is an upcoming trial date.
I’ve found this to be true even for some of the average or above average insurers like Crum and Forster, Travelers, FIGA, and others.
Will the Florida department take any other action against the insurance company?
A consumer complaint may be filed with the DFS Division of Consumer Services indicating that a company may be engaged in a pattern or practice of fraudulent activity.
If so, the division may refer the complaint to the Market Investigations unit for review. If Market Investigations uncovers potential violations, then the complaint may be referred to the DFS Division of Insurance Fraud.
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Editor’s Note: This post was originally published on August 2014 and has been completely revamped and updated.
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