Consumer Complaint Form

Consumer complaints may only be filed by the person having problems with your own insurance, agent or claim. If this is not regarding your own insurance or your own claim, please contact us at 208-334-4319 for assistance.

* Denotes required fields

Your Contact Information

First Name *

Middle Name

Last Name *

Address Line 1 *

Address Line 2

City *

State *

Zip *

Phone *

Email (required if correspondance selected is via email) *

Other Contact Info

How do you prefer we correspond with you? *

Insurance Information

Complete name of Insurance Company involved

Is your insurance provided by an employer or other group? *

Group Name

Policy Holder Name

Policy Number

Claim Number

Date Loss Occurred

Does your complaint concern an Insurance Agent, Bail Agent, or Title Agent? *

Other Information

Have you previously written to the Department of Insurance about this matter? *

Previous File Number

Have you reported this matter to another governmental agency? *

Do you have an attorney representing you? *

Is there a court action pending? *

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) * Limit of 4,000 characters

What do you consider to be a fair resolution to your complaint/problem? * Limit of 2,500 characters

Attachments (Please check if you have attachments to send 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.

Do you agree to the above terms? *