To file a complaint against a life or homeowners insurance company with the Louisiana Department of Insurance, you need to complete the Complaint Report Form thoroughly. Our insurance dispute attorney can help you get back on track. Here’s a detailed explanation of what information is required for each section of the form:
Section I: Personal Information
- Your Name: Provide your full legal name.
- Home Phone: Your home phone number.
- Address: Your full residential address including street, city, and zip code.
- Work Phone: Phone number where you can be reached during work hours.
- City, State, Zip: Specific location details.
- Cell Phone: Your mobile phone number.
- Insured: This may be your name if you are the policyholder. Look at the policy.
- Email: A valid email address for communication.
- Claimant: Specify the name of the insurance claimant’s name here.
- Date of birth: The claimant’s date of birth.
- Social Security # (last four digits): Last four digits of your social security number.
- Age Group: Mark the box that corresponds to your age category.
Section II: Complaint Information
- Who is the complaint against?: Full and exact name of the insurance company, broker, agent, or adjuster.
- Address (if known): The official address of the company or individual being complained about.
- What type of coverage does this involve?: Check the appropriate box(es) that apply to your situation (e.g., Life, Homeowners, etc.).
- Policy Number, Group Number, Claim Number: These identifiers help specify the exact policy or claim involved.
- If involving group insurance, name of the employer: If your policy is through an employer, provide the employer’s name.
- Date of loss: The date on which the incident that led to the claim occurred.
Section III: Legal and Detailed Complaint Information
- Do you have an attorney representing you?: Indicate whether you have legal representation.
- Is there any court action pending?: Indicate if there is ongoing litigation related to the complaint.
- Have you previously reported this problem to our office or any other agency?: If yes, mention to whom and provide the file number if available.
- Reasons for your complaint: Check all reasons that apply such as Claim Denial, Claim Delay, Unfair Offer/Payment etc.
- Describe your problem: Write a detailed account of your issue, using additional sheets if necessary. 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?: Describe the outcome you are seeking.
- Signature and Date: Sign to certify that the information provided is accurate and understand that it may be shared with the involved parties.
Additional Documentation to Include
- Copies of all relevant correspondence with the insurance company or agent.
- Copies of relevant sections of your policy or benefits handbook.
- Any sales literature or worksheets related to your policy.
- A copy of your insurance ID card, if possible.
- The initial claim you filed, if applicable.
HELP FROM A LOUISIANA INSURANCE LAWYER
If you are a victim of your insurance company and and your claim has been denied, delayed or underpaid or you have questions about your claim, call and insurance lawyer at 866-558-9151 or submit your inquiry online. Please be advised that you may be facing important legal deadlines, so don’t delay.
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This post is general information about legal developments, not legal advice. It may discuss court decisions, statutes, or regulations without describing every fact, issue, or exception that could apply, and state and federal law changes over time. No representation is made that this post is accurate, complete, or current, either now or at the time it was published. Reading it does not create an attorney-client relationship. See our full Disclaimer, and contact our office to discuss your specific situation.