How to Make a DOI Complaint in Georgia Complete Guide (PDF)
This step-by-step guide on how to place a formal complaint can help you find the best solution to any problems you might be facing with an insurance company or the way they are dealing with your request.
- Verify Eligibility of Your Complaint
- Reach Out to Your Insurance Company for Resolution
- Prepare the Necessary Information
- File Your Complaint
- Following Actions
1. Verify Eligibility of Your Complaint
The Consumer Services Division handles various insurance-related complaints, but it does not have jurisdiction over the following plans:
- Self-insured employers and health and welfare benefit plans: Some large employers provide health benefits to their employees through self-insured plans. While these plans are often administered by insurance companies, the employer, not the insurance company, assumes the risk for claim payments. State insurance regulations do not apply to self-insured employer plans under federal law. The same exemption applies to health and welfare benefit plans, such as union plans.
- Federal Employees’ health and life insurance
- Medicare HMOs
- Military Insurance
- Medicare
- Medicaid
- State of Georgia Employee’s Health Plan
- University System of Georgia
- Policies purchased in another state
2. Reach Out to Your Insurance Company for Resolution
Before contacting the Consumer Services Division about your dispute, follow these steps with your insurance company:
- Express your complaint to the company’s representative.
- Inquire about the necessary steps to submit your dispute (e.g., drafting a formal complaint letter, completing specific forms, providing supporting documentation, etc.).
- Maintain thorough records of all interactions with the insurance company concerning your dispute. When making phone calls, record the call date, the representative’s name, and the phone number dialed, and summarize the conversation. Keep copies of all written correspondence, including emails.
- Collect and send all required documentation to the address provided by your insurance company. Remember to send copies (not originals) of personal supporting documents like invoices, notes, canceled checks, notices, etc.
If you cannot resolve your dispute with the insurance company or are dissatisfied with their response, proceed to Step 3.
3. Prepare the Necessary Information
To ensure we have all the essential details to investigate your complaint, please provide the following:
- Personal information (address, name, phone number, and email address)
- The precise name of your insurance company
- The full name of any agent or adjuster involved
- Your policy number
- The number of your claim and the date of loss (if pertinent)
- Insurance card information, both sides
- A brief description of your problem
- Copies (not originals) of all supporting documentation, including invoices, canceled checks, advertising materials, and any correspondence between you and the company or agent, etc.
4. File Your Complaint
You may submit a complaint on the Georgia Government website if you cannot resolve your dispute with the insurance company or are unsatisfied with their handling of your claim.
Please submit your complaint once only, as multiple submissions cause delays. Follow the instructions to complete the Complaint Form.
Mail to the Department of Insurance of Georgia, located at 2 Martin Luther King Jr. Drive, Suite 716 West Tower, Atlanta, Georgia 30334.
5. Following Actions
Once they receive your complaint, they will take the following steps, as applicable:
- Send you an acknowledgment letter containing your Case Number and the contact information of the assigned Complaints Analyst.
- Forward a copy of your complaint to the agency or company you complained about, requesting a detailed written response.
- Assess whether your issue was handled in accordance with the policy or certificate of coverage terms.
- Review your file to determine if the insurance company, HMO, insurance agent, or adjuster violated state insurance laws.
- Take enforcement action if any laws are violated.
After investigation, they will send you a copy of the company’s response, along with a formal letter explaining the outcome. One of the following actions may result from the review:
- If the complaint is resolved, they will send you a letter outlining the resolution.
- If an insurance law is violated, the company will be required to take corrective action.
- If the company is not adhering to the policy, they will request corrective action.
- If the insurer or producer has not responded adequately or thoroughly investigated the complaint, they will be required to do so.
