Step By Step Guide to Filing a Complaint with the California Department of Insurance

Are you thinking about filing a complaint with the California Department of Insurance? Here are some of the most common reasons property owners decide to take this step:

  1. Their insurance company did not properly investigate their claim.
  2. Their insurance company denied their claim without valid reason.
  3. Their insurance adjuster is not returning their phone calls and emails.
  4. Their insurance adjuster told them a check is on its way and it’s been over 30 days and they’re starting to doubt whether this is true.
  5. Their insurance adjuster is not willing to send a local licensed general contractor to write a fair estimate to repair their property.
  6. The amount the insurance adjuster is willing to pay is not sufficient to cover the cost of the repairs.
  7. The property owner has not been able to find a general contractor who will perform the work for the amount in the insurance adjuster’s provided estimate.

Are you going through any of these experiences? If so, you should definitely consider filing a complaint. After you’re done reading the guide, make sure you also read why it’s sometimes in your best interest to hire a Public Adjuster.

 

Here is our Step By Step Guide to How you File a Complaint with the California Department of Insurance:

Step #1: Visit the California Department of Insurance Website

Visit this Link: http://www.insurance.ca.gov/01-consumers/101-help/index.cfm

 

Step #2: Select “File a Consumer Complaint Online”

 

 

Step #3: Start the Process by Creating an Account

It’s important to create an account so that you can check in on the status of the complaint at a later date.

 

 

Step #4: Fill out all the necessary information to create your account

 

 

Step #5: Create a New Complaint

Select the appropriate button to start the complaint process.

 

 

Step #6: Select the Type of Insurance

Helpful Tip: Select the insurance type that applies. In most cases, if you’re dealing with water damage in your home, its homeowners, and if it’s a building for business, then you’re dealing with your commercial property insurance.

Is there a claim involved? If you’ve already opened a claim with your insurance, click Yes.

 

 

Step #7: Fill out Your Contact Information

If you’ve just created an account, this information should auto-populate.

 

 

Step #8: Fill Out all the Complaint Details

Having trouble finding this information? It can be found in most correspondences between you and your insurance adjuster.

Helpful Tip: In the brief description section, reference any documentation that you wish to upload in the next step of the process.

 

 

Step #9: Upload any relevant documents and attachments

 

 

Step #10: Sign the Authorization Form

 

Why Filing a Complaint Is Not Necessarily Your Best Option

The California Department of Insurance (CDI) investigates complaints against insurance companies and can audit claim files to determine compliance with legal requirements. They typically look for patterns – if they receive many similar complaints, they may decide to take action.

When you file a formal complaint with the CDI, they will approach your insurance company to get their side of the story. However, they will typically not adjudicate (act as a judge) your case.

According to United Policyholders:

“The Department does not typically resolve disputes between individuals and insurers that involve large dollar disputes or coverage disputes. The CDI can help you get a copy of your policy, resolve small to medium sized problems, and they can identify and punish patterns of bad behavior.”

Based on the above, it’s unlikely that the California Department of Insurance will help resolve large or complex cases or coverage disputes.

Your best bet is to consult a public adjuster or lawyer who specializes in insurance cases.

Consult a Public Adjuster

When you file a claim under your homeowners insurance policy, your insurance company will appoint an insurance adjuster to handle the claim. The insurance adjuster is paid by your insurer to mitigate their liability and act in their best interests.

Dealing or negotiating with an insurance adjuster can be challenging, especially in large or complex cases where you might find yourself out of your depth. Should this be the case, your best bet is to consult a public adjuster.

The benefits of hiring a public adjuster include:

  • Looks after YOUR Best Interests – A public adjuster looks after YOUR best interests and not those of your insurance company. By hiring a public adjuster, you can even the playing field by having someone on your side who speaks the same language as an insurance adjuster.
  • Makes the Claim Process Less Stressful – Managing a large or complicated insurance claim on your own can be stressful. It forces you to do something you’re not familiar with and takes you out of your comfort zone. By hiring a public adjuster to manage your claim you can save yourself a lot of headaches.
  • Helps You Fight a Bad Settlement Offer – If you have received a bad settlement offer, a public adjuster can help secure a better offer for you.
  • Saves You Time – Managing an insurance claim can be time-consuming, labor-intensive, and might feel like a full-time job. Hiring a public adjuster can save you a lot of time!
  • Negotiates on Your Behalf – Insurance adjusters know the ins and outs of insurance claims. Negotiating with an expert about a topic you know very little about puts you at a disadvantage. An experienced public adjuster knows how to negotiate with an insurance adjuster.
  • Faster Claim Resolution – Working with a public adjuster might speed up the claim process as they know what to do and how to do it right the first time.
  • Likelihood of a Higher Settlement Offer – Public adjusters understand the fine print in your homeowners insurance policy. They have the skills, knowledge, and experience to ensure you get the best settlement offer you’re entitled to under your insurance policy.

Consult an Attorney

Many homeowners immediately think of hiring an attorney if they can’t reach an amicable agreement with their insurance company. They typically follow this route when they are not aware of alternative solutions, such as hiring a public adjuster.

In most cases, litigation and the costs associated with it can be avoided if you do your homework before hiring an attorney.

Consider hiring an attorney if the only way forward is to pursue litigation.

Hiring an attorney is an expensive and often unnecessary option. Attorneys typically charge a contingency fee of 33% to 40% of the settlement amount plus any cost incurred by them in the process of settling your claim. This is significantly higher than what you might expect to be charged by a public adjuster.

It’s not uncommon for an attorney to use the services of a public adjuster. Before you hire an attorney, first discuss your case with a reputable public adjuster.

Consider hiring an insurance appraiser if your policy contains an appraisal clause.

An appraisal clause allows both you and your insurer to hire an insurance appraiser if you can’t come to an agreement on the amount of your loss.

An insurance appraisal is a process in which you and your insurer will make a good-faith attempt to resolve disputes without resorting to litigation. Note that such disputes concern the amount of loss and not coverage issues.

Property insurance appraisers are typically professionals like adjusters, contractors, engineers, or anyone with relevant, specialized knowledge who has no interest or stake in the outcome.

You and your insurer will each hire an appraiser, and the two appraisers will choose an umpire. Should the two appraisers be unable to agree on the amount of loss, they will submit their respective reports to the umpire. A decision agreed to by any two of the three parties (the two appraisers and the umpire) will set the amount of loss.

Note: Many insurance policies do not contain an appraisal clause. However, in California appraisal provisions are provided for under Insurance Code §2071(a).

That’s a Wrap

Filing a complaint with the California Department of Insurance is quick and easy. However, as explained in this article, it might be the least effective way to resolve a dispute between you and your insurance company. As such, submitting a complaint should typically be your last resort.

The best option is to hire a public adjuster.

An experienced, reputable, and licensed public adjuster can help you overcome the challenges of managing a large or complex claim by yourself. They can assist you in resolving disputes and complaints, and getting the best possible settlement offer you’re entitled to under your policy.

Avner Gat, Inc. has 17+ years of experience as a public adjuster covering Southern California. We protect homeowners from the games and fine print that insurance companies are known for.

Call Avner now at (818) 917-5256 to find out how we can assist you.

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