INSURANCE COMPLAINTS & FRAUD

INSURANCE COMPLAINTS

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Click the button below to file
your insurance complaint.
MONTANA ONLINE
COMPLAINT FORM

If you are submitting this complaint on behalf of another person, please include this signed third-party information disclosure authorization with your supporting documents.

Examples of insurance complaints include:

Insurance coverage issues, claim disputes, premium problems, sales misrepresentations, policy cancellations, and premium refunds. These types of complaints may involve insurance companies, producers, adjusters, consultants, and others.

  • If you feel your insurance claim has not been handled properly and you’ve read your insurance policy, contact the insurance company or your insurance producer (agent) and bring the problem to their attention.

  • Document your phone calls, include the date of the call, name of the person you spoke with, and make notes of your conversation. Keep copies of all written communications.

  • If you are still not satisfied and believe your claim has not been handled appropriately, you can submit a complaint to the CSI.

  • CSI Consumer Advocates are available to answer general questions by calling 800.332.6148 or 406.444.2040.

All complaints must be submitted in writing or online.

The Online Complaint Form, or a paper copy HERE, should be used for filing an insurance complaint.

In order for us to best serve you in handling your complaint, the CSI asks you to do the following:

  • Complete the Complaint Form in its entirety
  • Include as much information as possible
  • Provide copies of your supporting information (for example: all policies, riders, letters, phone logs)
  • Sign the paper form or submit electronically online

If submitting electronically, you will have the opportunity to upload additional supporting documentation.

To submit your paper form and supporting documentation, kindly print out and send via mail, email or fax at:

  • Mail:
    • Montana Insurance Department, Attn: ICS | 840 Helena Avenue | Helena, Montana 59601

  • Email: ics@mt.gov

  • Fax: 406.444.1980

If you are submitting this complaint on behalf of another person, please include this signed third-party information disclosure authorization with your supporting documents.

  • When the CSI receives your complaint, you will receive an acknowledgment letter that will include the contact information of your dedicated Consumer Advocate, along with your complaint file number. Please refer to the complaint file number when you call or write to the CSI.

  • We will then contact the relevant parties for a detailed explanation of their position. When a response to the complaint is received from the company or producer, the Consumer Advocate will review the response and contact you to discuss.

  • This review will result in one of the following actions, which will include a corresponding letter you regarding the disposition:

    • —If the insurer is not complying with the terms of the insurance policy or Montana insurance law has been violated, the CSI will request corrective action.

    —If the complaint has been resolved, your complaint file will be closed.

    There may be some unforeseen delays if the parties need more time to gather additional information in order to fully address your concerns. If this occurs, your Consumer Advocate will keep you informed of the status of your file.

CSI Consumer Advocates answer hundreds of insurance questions every day. If you’re not sure if we can help you, call our office at 800.332.6148 or 406.444.2040.

What we can do:
  • Help you understand your insurance policy.
  • Assist you with insurance-related complaints.
  • Require the insurance company to provide an explanation for their actions as it involves your complaint.
  • Review the company’s response to make sure they followed Montana insurance laws and the terms of your policy.
  • Require the company to take corrective action if they didn’t follow Montana law or the terms of your policy.
  • Assist you with appeals of denied health insurance claims. Read the CSI guide to internal appeals and external review for more information.
What is outside of our authority:
  • Regulating medical providers or facilities.
  • Acting as your lawyer, giving you legal advice or being your claims adjuster.
  • Making judgments or determining if further treatment is necessary.
  • Making liability decisions or determining who is at fault.
  • Establishing the facts surrounding a claim (for example: who is being truthful when there are conflicting reports of the situation).
  • Determining the cause of loss, value of a claim, or acting as your adjuster.
  • Addressing complaints with entities over which the CSI has no regulatory authority.
Below is a list of helpful contact information:
  • Self-funded employer health plan, contact the U.S. Department of Labor at 866.444.3272 or your employer.
  • TRICARE—888.874.9378
  • Montana Municipal Interlocal Authority (MMIA)—800.635.3089
  • Federal Employees’ Health Plan and life insurance—202.606.1800
  • Medicare Advantage or Medicare Part D—800.633.4227
  • Medicaid—800.362.8312
  • Worker’s compensation—406.444.1574
  • State of Montana employee health benefits plan—406.444.7462
  • Montana Unified School Trust (MUST)—406.457.4404

INSURANCE FRAUD

Suspect insurance fraud?
Click the button below and
report it.
REPORT
INSURANCE FRAUD

Insurance fraud happens when a person makes a fake insurance claim to obtain benefits or compensation to which they are not entitled. It is often seen as a victimless crime—it’s not. It’s a cost everyone pays through increased premiums. You can play a pivotal role in stopping insurance fraud by reporting it.  Examples of fraud can involve all types of insurance—health, auto, property, and life.