This form is a Complaint For Declaratory Judgment To Determine ERISA Coverage. Adapt to your specific circumstances. Don't reinvent the wheel, save time and money.
Indiana Complaint For Declaratory Judgment To Determine ERISA Coverage
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How to fill out Complaint For Declaratory Judgment To Determine ERISA Coverage?
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You can submit a complaint online or download a printable form to mail to IDOI at 311 W. Washington Street, Suite 300, Indianapolis, IN 46204-2787 or fax to 317-234-2103. The form requests your contact information, the name of the insurance company, agency, or agent involved, and the applicable policy or claim number.
A plaintiff seeking declaratory relief must show that there is an actual controversy even though declaratory relief will not order enforceable action against the defendant. An actual controversy means there is a connection between the challenged conduct and injury, and redressability that the court could order.
To ask an insurance question: Call 800-622-4461 or 317-232-2395. Email consumerservices@idoi.in.gov.
Department's complaint form, contact our office toll-free at (877) 527-9431. When your complaint is received, a file number will be assigned and you will be sent written notification of that number.
Consumer complaints against insurance companies must be received in writing. You may file a complaint using our Online Consumer Complaint Portal. You may print off our Insurance Complaint Form and mail or fax the completed form to the Consumer Services Division.
The IDOI has the authority to regulate (i.e., license, review rates and policies, review financial statements, investigate complaints, conduct examinations and issue orders/penalties) all insurance companies, producers, premium finance companies, motor clubs and HMO's that are licensed to conduct business in Indiana.