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

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

Section 2: Insurance Company Information

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')
2Policy number(s) involved
3Type of insurance (auto, home, life, health, etc.)
4Policy effective date and renewal date
5Agent or broker name and contact info (if applicable)
6Claims adjuster name(s) and contact info

Section 3: The Specific Claim or Issue

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

Section 4: The Denial or Dispute (if applicable)

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

Section 5: Communication Timeline

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

Section 6: Documentation to Attach

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

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

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

How to file your complaint

1. Find your state Department of Insurance website (search “[state name] department of insurance consumer complaint”).
2. Most states accept online complaints through a portal; some accept written complaints mailed in.
3. Use this worksheet to gather information BEFORE filling the form — incomplete submissions delay processing.
4. Attach all supporting documents (denial letter, policy declarations, evidence).
5. Keep a copy of your complete complaint and confirmation number.
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. 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.

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.

Section 2: Insurance Company Information

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')

2Policy number(s) involved

3Type of insurance (auto, home, life, health, etc.)

4Policy effective date and renewal date

5Agent or broker name and contact info (if applicable)

6Claims adjuster name(s) and contact info

Section 6: Documentation to Attach

1Copy of the policy declarations page

2Copy of the denial letter (or underpayment EOB / settlement letter)

3Photos and other evidence supporting your position

4Independent estimates if applicable

5Medical records, repair estimates, police reports, etc.

6Your written communication log (date, time, person, what was said)

7Copy of your internal appeal and the insurer's response (if any)

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

1Whether the insurer followed state regulations on timeliness, communication, and documentation

2Whether the denial is supported by the policy contract as written

3Whether the insurer's investigation was thorough and good-faith

4Whether the settlement offer adequately reflects the documented loss

5Any specific regulatory violations you believe occurred

How to file your complaint

1. Find your state Department of Insurance website (search “[state name] department of insurance consumer complaint”).

2. Most states accept online complaints through a portal; some accept written complaints mailed in.

3. Use this worksheet to gather information BEFORE filling the form — incomplete submissions delay processing.

4. Attach all supporting documents (denial letter, policy declarations, evidence).

5. Keep a copy of your complete complaint and confirmation number.

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. 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.

DOI Complaint Prep Worksheet

Section 1: Policyholder Information

Section 2: Insurance Company Information

Section 3: The Specific Claim or Issue

Section 4: The Denial or Dispute (if applicable)

Section 5: Communication Timeline

Section 6: Documentation to Attach

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

How to file your complaint

Print or save as PDF

Related

DOI Complaint Prep Worksheet

Section 1: Policyholder Information

Section 2: Insurance Company Information

Section 3: The Specific Claim or Issue

Section 4: The Denial or Dispute (if applicable)

Section 5: Communication Timeline

Section 6: Documentation to Attach

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

How to file your complaint

Print or save as PDF

Related