(Note: This guest blog is by Liberty Ritchie, a Licensed Legal Intern in our Oklahoma City office)
The Arizona Department of Insurance (ADI) “helps insurance consumers resolve disputes that are within the Department’s jurisdiction, and…investigate apparent violations of Arizona law.”1 Specifically, the Investigations Division of the ADI investigates consumer complaints of wrongdoing by insurance companies, agencies, and agents, and the Market Oversight Division more broadly examines companies’ marketing and claim settlement practices. If you think that your claim has been delayed, unfairly denied, or otherwise poorly handled, you can file a complaint with the ADI requesting an investigation.
Before you file a complaint, you should know that ADI’s authority is largely limited to enforcing Arizona insurance law. It cannot act as your legal representative, make determinations of fact regarding your claim, or order an insurance company to pay you. It can always answer questions you have about your policy or the claims process. If you submit a complaint, it can also require your company to respond and review that response to see if the company or individual is complying with the applicable laws, regulations, and policy provisions.
With this in mind, you can file a complaint online or by mailing the proper form to the ADI offices at 100 North 15th Avenue, Suite 102 Phoenix, Arizona. The complaint forms can be found on ADI’s website under “Consumers > File a Complaint or Appeal.” This will take you to a page with various links to different forms. Under “Whom Do We Have the Pleasure of Assisting,” click “Insurance consumer, policyholder, enrollee/member, or beneficiary/claimant” and then select the kind of insurance your complaint is about. After making the appropriate selection, you will be asked if you believe that an insurance company or insurance professional has violated Arizona law. If so, you will be directed to an online complaint form. If not, you can still call ADI with questions about your insurance claim or policy at (602) 364-2499 (if you live in Phoenix) or (800) 325-2548 (if you live outside the Greater Phoenix Area).
The complaint forms request information about how to contact you, your insurance (like your company, agent, and policy number), and details about the insurance company or professional’s wrongdoing. Once you have fully described why you are submitting a complaint, you will have an opportunity to attach documents to help ADI investigate the issue. ADI recommends including scans of your policy, your insurance card, and any correspondence exchanged with your company or agent. You can e-mail supporting documents to insurance.consumers@difi.az.gov.
After your complaint and its supporting documentation is submitted, it will be assigned to an ADI specialist. Your specialist will send a copy of the complaint to the company or agent and request a response. The specialist will review the response along with all the information you provided to determine if there has been a violation of state law, regulations, or your policy. If a law has been violated, the ADI has the authority to impose fines or sanctions against the offending company, agency, or agent. If the specialist determines that no laws have been broken, she will reach out to you to let you know her decision, explain how she reached it, and discuss other possible solutions with you.
Navigating your insurance claim or policy can be frustrating and confusing. ADI is there to answer your questions, advocate for your rights, and ensure that insurance companies are following the rules. If you have other questions or concerns about your insurance claim, please do not hesitate to contact Merlin Law Group for a free case evaluation.
1 Arizona Department of Insurance and Financial Institutions, Filing a Complaint (n.d.), https://insurance.az.gov/complaint.