The Commissioner of Securities and Insurance has staff dedicated to helping consumers resolve complaints against insurance companies.
Before filing a complaint
- Contact the insurance company or agent and bring the problem to their attention. Document your phone calls by noting the name of the person you speak to, the date of the call and a brief summary of the conversation. Keep copies of all written communications.
- If you are not satisfied with the results you receive, contact us for assistance. Compliance Specialists are available to answer general questions by phone at our toll-free Consumer Assistance Hotline (800) 332-6148 or in Helena 444-2040.
- Complaints must be submitted in writing.
What happens after I file a complaint?
- When your complaint is received, a file number will be assigned and you will be sent written notification of that number. Please refer to the complaint file number when you call or write to the Commissioner.
- When a response to the complaint is received from the company or producer, a Compliance Specialist will review the complaint and response.
- This review will result in one of the following actions:
- If the complaint has been resolved, the complaint will be closed and you will be sent a letter.
- If an insurance law has been violated, the Commissioner will request corrective action.
- If the company is not abiding by the policy, the Commissioner will request corrective action.
- If the insurer or producer has not responded to all questions or has not investigated the complaint thoroughly, the Commissioner will require them to do so.
- If no violation of Montana insurance law is found, a letter will be sent to you with an explanation of the finding and notice that the investigation is being closed.
- In each instance, you will receive a written response from the Commissioner’s office explaining the results of our investigation.
Types of complaints the Commissioner can handle
The Commissioner handles most insurance problems involving home, business, auto, health, life, etc. Those problems may include coverage issues, claim disputes, premium problems, sales misrepresentations, policy cancellations, and refunds, just to name a few. The Commissioner will also investigate all complaints against insurance agents, adjusters and consultants.
The Commissioner’s office can assist consumers with appeals of denied health insurance claims. Read the Commissioner’s guide to internal appeals and external review for more information. If you have questions about appealing a denied claim, please call the Commissioner’s office at 800-332-6148.
Actions the Commissioner cannot take on your behalf
- Act as your legal representative or give you legal advice;
- Intervene in a pending lawsuit, on your behalf;
- Consult with you if you are represented by an attorney unless we have your attorney’s written permission;
- Recommend an insurance company, producer or policy;
- Identify another person’s insurance company;
- Resolve a dispute between you and your insurance agent or company when the only evidence is your word against the word of the producer or company;
- Make medical judgments;
- Determine the value of damaged or stolen property or conclude who was at fault for an accident;
- Establish the facts surrounding a claim (such as who is being truthful when there are differing accounts of what happened);
- Investigate an insurance complaint filed by a medical service provider, contractor, auto repair shop or any other outside party without the written authorization of the consumer; or
- Address plans that the Commissioner has no regulatory authority over, including MMIA (Montana Municipal Insurance Authority) and rental car agencies.
Plans over which the Commissioner’s office has no authority
NOTE: If the Commissioner’s office does not have authority over your complaint, you will be referred to the proper authority. If you have questions about the types of complaints the Commissioner has the authority to resolve, please call 800-332-6148.
- Federal employees’ health plan and life insurance — Call: (202) 606-1800
- Medicare Advantage or Medicare Part D — Call: (800) 633-4227
- Medicaid — Call: (800) 362-8312
- State Fund workers compensation — Call: (406) 444-1574
- Worker’s compensation claims disputes — Call: (406) 444-1574
- Self-funded employee health benefit plans — Call: (866) 444-3272
- State-sponsored, self-insured health plan for teachers and state employees — Call: (406) 444-7462
- Any self-insured governmental plans — Call your employer
FOR SELF-FUNDED HEALTH PLANS: The Commissioner’s office can assist consumers with appeals of denied health insurance claims. Read the Commissioner’s guide to internal appeals and external review for more information. If you have questions about appealing a denied claim, please call the Commissioner’s office at (800) 332-6148.
Other helpful resources
For more help with specific issues, check the list of organizations below.
- If you are covered under a Medicare, Medicare Advantage, or Medicare Part D drug plan, contact the Centers for Medicaid and Medicare Services at 1-800-MEDICARE or (800) 633-4227.
- If your complaint involves a workers’ compensation claim, contact the Workers’ Compensation Claims Assistance Bureau (406) 444-1574.
- If your complaint involves a federal health or life insurance plan, contact the U.S. Office of Personnel Management at (202) 606-1800.
- If you’re insured through the U.S. military and a Montana resident, contact TRICARE at (888) 874-9378.
- If you bought your policy in another state, contact that state’s insurance commissioner’s office.
- If you are covered by a self-funded employer health plan, contact the U.S. Department of Labor at (866) 444-3272 or your employer.
Online Complaint Form