Print hard copy of the completed form. If you wish to give authority to someone to assist you in filing a complaint, please complete the Authorization and Designation of Agent form in addition to the Request for Assistance Form.
Attach supporting documents.
Mail all documents to the address listed on the RFA form.
Examples of Complaints Addressed by the California Department of Insurance
Improper denial or delay in settlement of a claim
Alleged illegal cancellation or nonrenewal of an insurance policy
Problems concerning insurance premiums and rates
Alleged misconduct by an agent or broker (misrepresentation, theft of premiums, etc.)
Problems relating to medical necessity of a treatment, an experimental or investigational therapy for certain medical conditions, or a claim denial for emergency or urgent medical services.
Independent Medical ReviewProgramand Related Documents