Louisiana Department of Insurance
Complaint Report Form
What the Louisiana Department of Insurance can do for you:
• Protect you by enforcing Louisiana’s insurance laws
• Provide you with consumer information
• Investigate your complaints against companies or agents
Types of complaints include:
• Sales/Policyholder Services • Claim Delays/Denials/Unsatisfactory Settlements
• Premium Rates/Refunds • Other Insurance-Related Disputes
• Cancellation/Non-Renewals
Types of insurance involved include:
• Life • Homeowners • Bail Bonds • Worker’s Compensation
• Health • Long Term Care • Commercial • Disability
• Auto • Credit • Annuity • Medicare Supplement
• Other Types of Insurance
What the Louisiana Department of Insurance cannot do for you:
• Give you legal advice, act as your lawyer, or interfere in a pending lawsuit
• Recommend one insurance company, agent or adjuster over another
• Decide disputes based on who is negligent or at fault
• Determine the facts surrounding a claim (that is who might be telling the truth in a
matter when accounts of the matter differ)
• Resolve a complaint if the only evidence is your word against the word of others
What should I send with my complaint form?
Copies, not originals of…
• Letters you have written to the company or producer dealing with the problem
• Letters you have received from the company or producer
• Other letters written about the problem from your doctor or lawyer
• Your policy or the excerpt from your benefits handbook that covers the situation
• Relevant sales literature or worksheets
• Your insurance ID card (copied front and back), if possible
• The claim you filed, if applicable
What happens after the Department of Insurance receives my complaint?
1. Typically, within a week of receiving your complaint the Louisiana Department of
Insurance will send you an acknowledgment letter or email noting:
• Your file number
• The name of the compliance examiner in charge of investigating your complaint
2. The Department of Insurance will send a copy of your complaint to the company or other
appropriate party and ask for an explanation of its position.
3. Your examiner will review all responses received to assure the problem has been
properly addressed. This may result in more letters or phone calls between the examiner,
the company and other parties.
4. Your examiner will send you a letter with the investigation results:
• If no evidence of a violation is found, the examiner will so advise and explain why the
investigation is being closed.
• If your examiner is not satisfied with the company’s response, the investigation will
continue.
• If the Louisiana Department of Insurance asserts that the law has been violated, the
Department will pursue administrative action to correct and punish the wrongdoer.
How will I know how the investigation is going?
• The average complaint takes approximately 45 days to investigate fully. Because of
the unique nature of each complaint, your complaint may be completed in a much
shorter time frame or, in some rare instances, take considerably longer.
• If you have any new information, put it in writing. Include your file number and send
it to your examiner.
For more information, free copies of our publications, or answers to insurance-related questions, contact the
Louisiana Department of Insurance at 1-800-259-5300 or (225) 342-5900 in Baton Rouge, or write to Louisiana
Department of Insurance, P.O. Box 94214, Baton Rouge, LA 70804-9214. You can access our website at
www.ldi.la.gov and or send an email to [email protected]v
.
Louisiana Department of Insurance
P.O. Box 94214, Baton Rouge, LA 70804-9214
Call toll free, 1-800-259-5300; Locally, call 225-342-5900
PLEASE TYPE OR PRINT CLEARLY
Section I
Your Name:
Home Phone:
Address:
Work Phone:
City:
State:
Zip:
Cell Phone:
Insured:
Email:
Claimant:
Date of birth:
Social Security # (last four digits):
Age Group: Under 25 25 – 49 50 – 64 65 +
Section II
Who is the complaint against? (Full and exact name of the company, broker, agent, or adjuster)
Address (if known)
What type of coverage does this involve?
Life Homeowners Bail Bonds Worker’s Compensation
Health Long Term Care Commercial Disability
Auto Credit Annuity Medicare Supplement
Other:
If involving group insurance, please provide the name of the employer:
Policy Number: Group Number:
Claim Number:
If your complaint is against another person’s insurance company, that person’s name, contact information,
and policy number:
Date of loss:
Section III
Do you have an attorney representing you? Yes No
Is there any court action pending? Yes No
Have you previously reported this problem to our office or any other agency? Yes No
If yes, to whom?
File number (if applicable):
Please check the reasons that apply to your complaint.
Claim Denial Claim Delay Rate Cancellation/Nonrenewal
Premium Refund Agent Handling Unfair Offer/Payment
Other:
Describe your problem in your own words. If more space is needed, please use extra sheets. Enclose copies
(NOT ORIGINALS) of available documentation relative to your complaint, including any applicable ID cards,
front and back.
What do you consider to be a fair resolution to your problem?
Please read and sign the following statement:
To the best of my knowledge, the information contained herein is true and accurate. I understand that a
copy of this form and any or all of the information attached may be sent to the party complained against.
(Signature)
(Date)
