DOI Complaint Prep Worksheet

Every state Department of Insurance accepts consumer complaints — and most resolve a meaningful fraction of disputes in the complaint stage because insurers want to avoid adverse regulatory records. This worksheet helps you organize a strong complaint.

DOIs cannot order a payout in most states

A state DOI typically cannot order an insurer to pay a specific amount. What it CAN do is investigate whether the insurer followed regulatory requirements (timeliness, communication, documentation), assess penalties for violations, and create a regulatory record that often motivates insurers to revisit disputed claims. For binding rulings on dollar amounts, you may need litigation or the appraisal clause in your policy.

This content is educational and is not legal, financial, or insurance advice. Coverage decisions depend on your specific situation, risk tolerance, and the actual policy contract you’re offered. For a binding recommendation, speak with a licensed insurance attorney for large or complex claims, or a public adjuster for property-claim valuation disputes, or contact your state Department of Insurance.

Section 1: Policyholder Information

  1. 1Your full legal name
  2. 2Mailing address (and property address if different)
  3. 3Phone number and email address
  4. 4Best time to be contacted by the DOI

Section 2: Insurance Company Information

  1. 1Insurance company legal name (often differs from the brand — e.g., a State Farm policy may be issued by 'State Farm Mutual Automobile Insurance Company')
  2. 2Policy number(s) involved
  3. 3Type of insurance (auto, home, life, health, etc.)
  4. 4Policy effective date and renewal date
  5. 5Agent or broker name and contact info (if applicable)
  6. 6Claims adjuster name(s) and contact info

Section 3: The Specific Claim or Issue

  1. 1Claim number(s)
  2. 2Date of loss (incident date)
  3. 3Date the claim was filed
  4. 4Brief description of what happened (1-2 paragraphs, factual, no editorializing)
  5. 5Estimated damages or claim amount
  6. 6Current claim status (denied, underpaid, delayed, etc.)

Section 4: The Denial or Dispute (if applicable)

  1. 1Date of denial letter or underpayment communication
  2. 2Insurer's stated reason for denial or underpayment
  3. 3Specific policy provision the insurer cites
  4. 4Whether you've filed an internal appeal with the insurer (and date / outcome)
  5. 5What you believe is incorrect about the insurer's position

Section 5: Communication Timeline

  1. 1Date you reported the loss
  2. 2Date(s) the adjuster contacted you
  3. 3Date(s) of inspections
  4. 4Date you submitted documentation requested by the insurer
  5. 5Date(s) you submitted appeal(s)
  6. 6Any periods of unexplained delay or non-response

Section 6: Documentation to Attach

  1. 1Copy of the policy declarations page
  2. 2Copy of the denial letter (or underpayment EOB / settlement letter)
  3. 3Photos and other evidence supporting your position
  4. 4Independent estimates if applicable
  5. 5Medical records, repair estimates, police reports, etc.
  6. 6Your written communication log (date, time, person, what was said)
  7. 7Copy of your internal appeal and the insurer's response (if any)

Section 7: What You're Asking the DOI to Investigate

  1. 1Whether the insurer followed state regulations on timeliness, communication, and documentation
  2. 2Whether the denial is supported by the policy contract as written
  3. 3Whether the insurer's investigation was thorough and good-faith
  4. 4Whether the settlement offer adequately reflects the documented loss
  5. 5Any specific regulatory violations you believe occurred

How to file your complaint

  1. 1. Find your state Department of Insurance website (search “[state name] department of insurance consumer complaint”).
  2. 2. Most states accept online complaints through a portal; some accept written complaints mailed in.
  3. 3. Use this worksheet to gather information BEFORE filling the form — incomplete submissions delay processing.
  4. 4. Attach all supporting documents (denial letter, policy declarations, evidence).
  5. 5. Keep a copy of your complete complaint and confirmation number.
  6. 6. The DOI typically forwards the complaint to the insurer for a written response within 15-30 days. You’ll be copied on the insurer’s response.
  7. 7. The DOI reviews the insurer’s response and issues a finding. Many disputes resolve here, especially when the insurer realizes the issue is now on regulatory record.

Print or save as PDF

Use your browser’s print function (Ctrl/Cmd+P) to print this worksheet or save it as a PDF. Fill it out by hand or in a word processor before submitting your complaint through your state DOI’s portal.

Related

State complaint guide
Full guide to filing DOI complaints
Claim denied workflow
8-step response to denial or underpayment
Denial reasons explained
17 common denial reasons + rebuttal evidence
Bad faith insurance
When a denial may rise to bad faith litigation

Important Disclaimer

This site provides general educational information only and is not a substitute for professional insurance advice. All rates, data, and coverage details are estimates and may not reflect your actual premiums. Insurance availability and pricing vary by state, insurer, and individual risk factors. Always consult a licensed insurance professional in your state before making coverage decisions.