Insurance Complaint Instructions

What We Do:

The Department of Commerce and Insurance is responsible for regulating and supervising insurance companies, agents, public adjusters, and brokers. Our authority to do so is outlined in the insurance laws and regulations of the State of Tennessee. We serve to protect the public from willful violations of the insurance code or other state laws.

Consumer Insurance Services is here to assist you with your insurance inquiry or complaint. We handle most insurance problems involving homeowners, automobile, health, life, dental, disability, annuities, just to name a few. We have the authority to review complaints against insurers, agents, public adjusters, and brokers, assist in providing complaint mediation, and enforce insurance laws on behalf of a consumer who feels he or she was treated unfairly. In order to resolve a claim dispute, the Division takes an active role as a third-party mediator. The insurance specialist assigned to a case must determine if the involved insurance company or agent has conducted its affairs in accordance with accepted business principles and is acting in accordance with Tennessee insurance laws and regulations. Mediation procedures include correspondence with the insurance company, the insurance agents, and the inquiring party, in addition to a thorough review of all related documentation. We also host insurance education seminars and speak to organizations that would like information about insurance and insurance-related products through our Speaker Request Form. Our primary responsibility is to you, the consumers of Tennessee. We want to ensure your insurance rights under your insurance contract and/or the laws and regulations of Tennessee have not been violated.

What We Can Do:

• Present your complaint to the insurance company.
• Obtain information or explanations on your behalf from the insurance company or its representatives. This may involve written and verbal contact with the companies or persons.
• Review in detail the information obtained from the company for compliance with applicable statutes, regulations, and policy contracts.
• Explain the provisions of your policy.
• Suggest actions or procedures you may take that could aid in resolving your insurance problems.

What We Cannot Do:

• Act as your lawyer or give legal advice.
• Recommend an insurance company, agent, or policy.
• Identify an insurance company with which a particular person or entity may have a policy.
• Resolve disputes of fact when the only evidence is your word against the word of the producer or company.
• Make medical judgments.
• Make determinations related to the facts of a case (for example, we cannot determine the value of damaged or stolen property or conclude fault).
• Negotiate Third-Party settlements.
• Force a company to satisfy you if no regulations have been broken.

We Do Not Have Jurisdiction Over These Plans:

• Workers' Compensation Injury Claims (See Tennessee Bureau of Workers’ Compensation (BWC) Administration Page)
• Self-Insured Employee Health Insurance Programs (See US Department of Labor Employee Benefits Security Administration)
• Union Plans (health and welfare plans)
• State of Tennessee Employees' Health Insurance (See Tennessee Partners In Health Benefits Administrators Page)
• Federal Employees' Health and Life Insurance (See Office of Personnel Management Federal Employee Guide)
• Entities we do not license (For example, Discount Drug Cards)
• Military Insurance (See TRICARE)
• Policies purchased in another state (Contact the state where the policy was purchased)
• TennCare (See the TennCare Oversight Division Page)
• Medicare Part A, B, C, and D (See the Federal Medicare Complaint Form)

Before Filing a Complaint

1. Contact the insurance company or agent and bring the problem to their attention. Document your telephone calls by noting the name of the person you speak with, the date and time of the call, and a brief summary of the conversation. Keep copies of all written correspondence.
2. If you are not satisfied with the results you receive, contact Consumer Insurance Services for assistance. Insurance Specialists are available to answer general questions by telephone at 615-741-2218 or, if outside Davidson County, 1-800-342-4029. Formal complaints must be submitted online.