Get State Of Indiana Indiana Department Of Insurance - In.gov - Secure In

Filling out the Indiana Department of Insurance complaint form is an important step for users wishing to address issues with their insurance companies. This guide provides clear and supportive instructions for completing the form accurately and efficiently.

Follow the steps to successfully complete your complaint form online.

1. Press the ‘Get Form’ button to retrieve the complaint form and open it for editing.
2. Complete your personal information in the designated fields, including your name, address, county, city, state, phone number, zip code, and email. Ensure that this information is accurate and clearly written.
3. Indicate the type of insurance by checking the appropriate box in section 1(A). If your complaint is related to a Medicare Supplement policy, provide the type in section 1(B).
4. In section 2, write the full name of the insurance company your complaint is against. Be specific to assist in processing.
5. Section 3 requires you to specify the state in which your policy was issued or purchased.
6. If an agent is involved in your case, fill in their name and address in section 4.
7. If a Navigator was involved, provide their name in section 5.
8. Enter your policy number and claim number, if known, in section 6.
9. In section 7, list the named insured as it appears on your policy.
10. If your complaint involves group insurance, provide the name and address of the employer in section 8.
11. If applicable, detail the location and date of any loss or accident related to your complaint in section 9.
12. Briefly describe the nature of your complaint in section 10. Attach additional sheets if more space is needed. Avoid including Social Security numbers.
13. Sign and date the form in the designated area to authorize the release of confidential medical and/or other information to the Department of Insurance. Ensure you understand that medical records are not public records.
14. After completing the form, review all entries for accuracy, save your changes, and prepare to submit the form as guided.

Complete your complaint form online today to ensure your issue is addressed promptly.