Department of Insurance

Consumer Complaint Form

Consumer complaints may only be filed by parties involved in the insurance contract. If you are unsure if you are an involved party; if your complaint involves an insurance matter or if the State of Idaho has jurisdiction, please contact us at 208-334-4319.

Your Contact Information

* Denotes required fields

Name First*

Middle

Last*

Address*

Line 2

City*

State*

Zip*

Phone *

Alternate Phone

How would you prefer we correspond with you?
U.S. Mail Email

Insurance Information

Complete name of Insurance Company involved

Is your insurance provided by an employer or other group?
Yes No

Name of the policyholder or defendant if different than your name

Policy Number

Claim Number

Date Loss Occurred

Does your complaint concern an Insurance Agent, Bail Agent or Title Agent?
Yes No

Other Information

Have you previously written to the Department of Insurance about this matter?
Yes No

Have you reported this matter to another governmental agency?
Yes No

Do you have an attorney representing you?
Yes No

Is there a court action pending?
Yes No

Complaint Information

Please describe the reason(s) for your complaint below (if you require more space than allowed in this box, please consider using the attach documents feature below) *

2500 Char Max

What do you consider to be a fair resolution to your complaint/problem? *

2500 Char Max

Please check if you have Attachments to send to us.

I am the person named above. To the best of my knowledge, the information contained herein is true and accurate. I understand that copies of this information and any documentation I have supplied may be sent to the party or parties complained about as part of Idaho’s Department of Insurance investigation, or to any other State or Federal Agency that may be able to assist me. Please check the box below to indicate that you agree to the statements in this paragraph.

I Agree (NOTE: BEFORE SUBMITTING INFORMATION YOU MUST READ AND AGREE TO THE ABOVE STATEMENT.)

If you would like a copy of your complaint please PRINT it before hitting the “Submit Complaint” button. Please click on Submit Complaint only once, and wait patiently. It may take some time for our system to process your entry. You will receive a confirmation if the form has successfully completed.

Consumer Complaint Form

Thank you for submitting your complaint to our online service.