The Consumer Services Division does not have jurisdiction over the following plans:

• Self-insured employers and health and welfare benefit plans – Many large employers provide health benefits for their employees through self-insured plans. Although self-insured plans are frequently administered by an insurance company, the employer (not the insurance company) bears the risk for paying claims. Federal law exempts self-insured employer plans from state insurance regulation. The same is true of health and welfare benefit plans (i.e., union plans).
• Federal Employees' health and life insurance
• Medicare HMOs
• Military Insurance
• Medicare
• Medicaid
• State of Georgia Employee’s Health Plan
• University System of Georgia
• Policies purchased in another state 
  • Note: HMO policies may be an exception. If you are covered by an HMO, please call our offices for assistance; you can find our contact information at the bottom of this page.

Before reaching out to the Consumer Services Division about your dispute, contact your insurance company and ask them to resolve the issue. 

• State your complaint to the company’s representative
• Ask them what you need to do to submit your dispute (e.g., write a formal letter of complaint, file any specific forms, provide supporting documentation, etc.)
• Keep meticulous records of all your communications with the insurance company regarding your dispute. When calling, note the phone number you called, the name of the person you spoke with, the date of the call, and write a brief summary of the conversation. Keep copies of all correspondence between you and the insurance company regarding the complaint, including all emails you send and receive.
• Gather and send all of the required documentation to the address provided by your insurance company. Note: you should send copies (not the originals) of all your personal supporting documentation, such as invoices, notes, canceled checks, notices, etc.

If you are unable to resolve your dispute with the insurance company or aren’t satisfied with how they respond to your claim, move to Step 3.

To help ensure that we receive all necessary information to investigate your complaint, please provide us with the following:

• Your contact information (name, address, telephone number, and email address)
• The exact name of the insurance company
• The full name of any agent or adjuster who may be involved
• Your policy number
• Your claim number and the date of your loss, if applicable
• A copy of both sides of your insurance card
• A concise description of your problem
• Copies (not the originals) of all supporting documentation, including invoices, canceled checks, advertising materials, and any letters between you and the company or agent, etc.

You may file a complaint with us if you are unable to resolve your dispute with the insurance company or aren’t satisfied with how they responded to your claim.

Processing and response times are faster through the Consumer Complaint Portal.

There are two ways to file your complaint. The most efficient and quickest process is the Online Consumer Complaint Portal. The submission using the form is a slower and more time consuming process.

Please only submit your complaint once. When multiple copies are submitted, it delays the process.

1. Once we review your complaint, we’ll do the following, where applicable:
   • Send you an acknowledgment letter that contains the following information:
     • Your Case Number
     • The name and contact information of the Complaints Analyst assigned to your case
   • Send a copy of your complaint to the agency or company you complained against and request a detailed written response.
     • Determine if your issue was handled appropriately under the terms of the policy or certificate of coverage.
     • Review your file to determine if the insurance company, HMO, insurance agent, or adjuster violated state insurance laws.
     • Take enforcement action when laws are violated.
2. Once we have completed our investigation, we’ll send you a copy of the company's response, with our formal letter regarding the completion of our investigation. Our review will result in one of the following actions:
   • If the complaint has been resolved, we will send you a letter explaining the resolution.
   • If an insurance law has been violated, we will request corrective action by the company.
   • If the company is not abiding by the policy, we will request corrective action.
   • If the insurer or producer has not responded to all questions or has not investigated the complaint thoroughly, we will require them to do so.
3. If you disagree with the Department’s response to your complaint:
   • Please send a written rebuttal along with any additional documentation that you have to your assigned Complaints Analyst.
   • The Complaints Analyst will send a copy of your rebuttal to the agency or company you complained against and request a detailed written response.
   • The Complaints Analyst will repeat Step 2 above after receiving the response to your rebuttal from the agency or company you complained against.
   • Note: If you need help finding an attorney, please contact the State Bar of Georgia Lawyer Referral Information Service.