Request for Assistance (RFA) (En Español)

Important Instructions - Please Read

Examples of the Types of Problems That You May Submit to the Department

1. Improper denial or delay in settlement of a claim.
2. Alleged illegal cancellation or termination of an insurance policy.
3. Alleged misrepresentation by an agent, broker, or solicitor.
4. Alleged theft of premiums paid to an agent, broker, or solicitor.
5. Problems concerning insurance premiums and rates.
6. Alleged improper handling of an escrow transaction by a title insurer or underwritten title company.

Examples of Complaints Which Do Not Come Within the Jurisdiction of This Department

1. Workers' Compensation Claims
2. Complaints concerning prepaid health plans or Health Maintenance Organizations

Before you file a complaint with the California Department of Insurance, you should first contact the insurance company, agent or broker in an effort to resolve the issue(s). If you do not receive a satisfactory response, then complete this form. Occasionally the issue may be of such a nature that attempting to contact the insurance company, agent, or broker first may not be appropriate. In these situations it would be appropriate to contact the Department first. When doing so, please provide as much information as space allows. Failure to provide this information may delay or even prevent our ability to be of assistance. Certain information is necessary to our review and within the powers and duties expressed in the California Insurance Code, Section 12921.3.

Please be aware that a copy of your Request for Assistance may be provided to the insurance company, agent or broker unless you indicate that you do not want a copy of your Request for Assistance forwarded.

In order for us to effectively begin our investigation you will need to provide supporting documentation with your Request for Assistance. Failure to provide supporting documentation may delay your request. Supporting documentation includes any documents (copies) related to your problem, such as the declaration page of your insurance policy or certificate, canceled checks, letters of claim denial or other correspondence. Do not send us originals of any documents, photographs or other evidence as we are not responsible for lost records or other items. The more complete the information we receive, the quicker we can identify the issues and begin our review. You may inspect the information you submit at any time as long as the Department's case is maintained.

If you have an attorney representing you in this matter or if there is a lawsuit currently ongoing or pending, our ability to mediate this matter is limited, but we will investigate your inquiry for any regulatory issues. However, if a lawsuit is pending, we may defer the regulatory investigation until the finality of the litigation. We ask that you still complete this form so we have a record of your issue.

The time it takes to handle a Request for Assistance can vary greatly, depending on how complex the matter is. Please be assured, your request will be handled as quickly as possible.

Examples of Complaints Which are Not Under the Jurisdiction of This Department

1. Workers' Compensation claims should be referred to:
   California Department of Industrial Relations
   Division of Workers' Compensation
   Information and Assistance Unit
   800-736-7401

2. Disability benefit claims under the Unemployment Act should be referred to:
   Employment Development Department
   State Disability Insurance (SDI)
   800-480-3287
3. Complaints concerning managed care health plans (health maintenance organizations (HMOs) and some preferred provider organizations (PPOs)), such as California Physicians' Service (dba Blue Shield of California), Blue Cross of California (formerly Wellpoint Health Networks, Inc.), Kaiser Foundation Health Plan Inc., etc. should be referred to:
   Department of Managed Health Care
   Help Center
   980 Ninth Street, Suite #500
   Sacramento, CA 95814
   Voice: (888) 466-2219
   Fax: (916) 255-5241
   TDD: (877) 688-9891
   DMHC's California Consumer Assistance Program

How to Contact This Department

All forms are to be used for new requests only. It is not necessary to submit another form if you have already sent a completed form or letter to us. If more than ten business days have passed without contact from us, please call our Consumer Hotline.

California Department of Insurance
Consumer Communications Bureau
300 South Spring Street, South Tower
Los Angeles, CA 90013
1-800-927-HELP (4357) or 213-897-8921
TDD Number: 1-800-482-4TDD (4833)
The Hotline hours are from 8:00 a.m. - 5:00 p.m., Mon. - Fri. (Except Holidays)

If you prefer to contact us using one of our online methods, please click on the appropriate link below. Failure to follow these instructions may delay CDI's response to your inquiry

For general questions or inquiries only, please use our Contact Us form.

To submit a complaint, please use one of the forms below:

Printable RFA (En Español)

1. Print hard copy and complete the form.
2. Attach supporting documents.
3. Mail the form and all supporting documents to CDI.

Internet RFA

1. If you have supporting documents, please do not use this form. Use the Printable RFA.
2. Print and keep a copy for your records.

If you are submitting information through the Internet, please review our privacy statement regarding information we obtain from you.