File a Complaint

How to appeal an insurer's denial

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Production courtesy of County Cable Montgomery,
Montgomery County, MD

Frequently Asked Questions: Appeal Hearings

The primary role of the Maryland Insurance Administration is to protect consumers from illegal insurance practices by ensuring that insurance companies and producers that operate in Maryland act in accordance with State insurance laws. We are here to assist you with your insurance inquiry or complaint about health, life, property and casualty insurance.

Our Rapid Response Program is designed to help certain consumers resolve property and casualty claims (such as auto and homeowners claims including those made under commercial lines policies) quickly and without having to file a formal written complaint. 

For more information, call us at 410-468-2340 or 1-800-492-6116 select option 3, then option 1.

 Participation in the Rapid Response Program is voluntary and does not affect your rights to file a formal complaint.

File a Complaint About:

Your HEALTH or LIFE Insurance

Your AUTO, HOME or Other Property Insurance

An Insurance Professional or Authorized Insurance Assistance Personnel

You also have the option of writing us a letter. CLICK HERE to see what information to include.

 

THIS IS WHAT WE CAN DO:

  • Forward a copy of your complaint to the insurance company, if appropriate;
  • Obtain information or explanations on your behalf from the insurance company or their representatives. This may involve written and verbal contact with such companies or persons;
  • Review in detail the information obtained from the company for compliance with statutes, regulations and policy contracts;
  • Explain the provisions of your insurance policy, as appropriate;
  • Suggest to you actions or procedures that you may take which could aid in resolving your insurance problem;
  • If it is determined that the actions of an insurance company are in violation of a statute, regulation or policy that the Administration enforces, we may take corrective action against that company.

 THIS IS WHAT WE CANNOT DO:

  • Assume the role as your legal representative, in or out of court;
  • Intervene in a pending lawsuit on your behalf;
  • In the case of disability insurance complaints, make a medical decision as to the extent of an individual's disability. We investigate complaints involving disability insurance to determine (1) whether or not the denial decision is arbitrary or capricious and (2) whether or not the denial decision was rendered in accordance with the terms of the insurance contract and State insurance laws and regulations.
  • Address complaints or inquiries involving insurance contracts that are not subject to the jurisdiction of the insurance laws of the State or matters governed by other State or Federal agencies. This would include the following:
  • Self-funded or self-insured plans
  • Medical Assistance (Medicaid)
  • Medicare and Medicare HMO's
  • Federal Employee Health Benefit Programs
  • Uniform Services Family Health Plans
  • Workers' Compensation
  • Contracts issued and delivered to the policyholder in another state.
    Review more information about the Maryland Insurance Administration's jurisdiction.
  • Make a decision as to disputes between you and insurance companies or their representatives which involve deciding matters as to:
    • Who is negligent or at fault;
    • The facts surrounding the claim (that is, who might be telling the truth in the matter when accounts of that matter differ);
    • The value of a claim or the amount of money owed to you; or
    • Any other factual disagreements between you and another party, unless the dispute involves a violation of law;
  • Ask the Motor Vehicle Administration to "hold" a fine pending the investigation of your complaint.

 

How to File an Insurance Complaint

 

Complaints must be received in writing, but there are three ways to submit complaints to the MIA. If your complaint involves the denial of coverage of health care services because the services were deemed unnecessary treatment, please refer to the Appeals and Grievances process.

 

File a Complaint Online

  • CLICK HERE to submit your automobile, homeowners, renters, or other property insurance complaint. Send us copies of relevant documentation later.
  • Because health insurance complaints involve private health records, these types of complaints can only be submitted by mail. The forms you need appear below:

Download Forms to be Completed by Hand

These forms should be as complete and detailed as possible and be accompanied by copies of any relevant documentation of your complaint. They may be mailed or faxed to the agency as directed below:

Submit a Written Letter

If you choose to send a letter, please provide the following:

    • Your name, address and daytime and evening phone number
    • Name of your insurance company, type of insurance (auto, homeowners, fire, etc.), policy number and claim number (if applicable)
    • Name of any other insurance company, agent, adjuster, etc. involved in your problem (provide as many names and phone numbers as possible)
    • A detailed explanation of the problem or situation
    • Copies of any documents that you think are important for the investigator to review. Do not send originals.
    • If your complaint pertains to health insurance, please provide a copy of your health insurance card or your policy.
    • If your complaint pertains to a denial of health care services, you will need to submit a medical records release form (which can be printed above).

Please understand that a copy of the complaint form and any or all of the enclosed information that you provide to us may be sent to the party the complaint is directed against (insurance company, agent, etc.)

NOTE: The Complaint process can take several weeks or a few months, depending on the complexity of the complaint. Sometimes, due to the mail, holidays, or the nature of the inquiry or complaint, the response time may take longer. We ask your patience and cooperation in allowing us to handle this matter for you.

 

Mail or fax this information to:

Maryland Insurance Administration
Attn: Consumer Complaint Investigation
(indicate if complaint is regarding Life/Health or Property/Casualty Insurance)
200 St. Paul Place, Suite 2700
Baltimore, MD 21202

Phone:

410-468-2000 or 1-800-492-6116

TTY:

1-800-735-2258

Fax:

410-468-2334 or 410-468-2307 (Property and Casualty)

 

410-468-2270 or 410-468-2260 (Life and Health/Appeals and Grievance)

 

If you need help filling out these forms or would like to submit them to an agency representative, visit us at one of our Consumer Outreach events.