Last Updated: January 23, 2024
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. If you have questions or problems, you may call us toll-free at 1-800-236-8517 (within Wisconsin) or 1-608-266-0103 (outside of Wisconsin) or
ask us a general insurance question.
Español: Presentar una queja ante OCI.
Before You File
Incomplete
complaint
submissions will
delay the
handling of your complaint. Before you file, click on all four sections below and follow the steps to properly submit your complaint.
Before reaching out to OCI about your dispute, contact the insurance company and ask them to resolve the issue.
- State your dispute 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 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 the 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 2.
Complaints We Can Help With
OCI handles complaints involving health, life and annuity, and property and casualty insurance companies and their agents. Examples of complaints include:
Complaints We Can't Help With
OCI is unable to assist with complaints related to:
Employer Self-Funded Health Plans
Medicare
BadgerCare Plus (Wisconsin Medicaid)
The Wisconsin Department of Health Services (DHS) administers the Wisconsin Medicaid program. Call 1-800-362-3
002.
Policies Purchased in Another State
What We Can't Do
Act as your lawyer or give you legal advice.
Make medical
judgments or determine who is at fault.
Establish the facts surrounding a
claim (for example: who is being truthful when there are different accounts of what happened).
Determine the value of a claim, the amount owed to you, or act as your adjuster.
Address issues we can't legally enforce.
- Tell a company to pay a claim, refund a premium, or reinstate or issue a policy (if they followed the law and your policy).
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
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Public Record Notice: Omit or mark out any confidential or personal information such as Social Security Numbers prior to submitting it to our office. Under Wisconsin's Open Records Law, all information you provide may become a public record once the file is closed. Only actual medical records obtained from a health care provider are confidential under s. 146.82, Wis. Stat.
Once you've gathered the required materials and documents, you're ready to file your complaint. Complaints may be filed online or through the mail. Select "Online Complaint" or "Mail Complaint" below to proceed.
File or Update Your Insurance Complaint
Select a filing option below. To request a paper complaint form be mailed to you, send an email to
ocicomplaints@wisconsin.gov.
Have a Pharmacy Benefit Manager or Surprise Medical Bill complaint?
Learn about filing those complaints here.
Next Steps
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A copy of your complaint will be sent to the company or agent. In addition to requiring a response to our office, we may ask that the company or agent also contact you directly to try to resolve the problem.
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You may hear from the company or agent in about 25 days from the date you send us your complaint. Either may contact you to try to clarify your concerns or attempt to resolve your issues.
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When we receive the information from the company or agent, we will review the file to determine what action we can take. We will then notify you of our determination.
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If our office is unable to obtain the resolution you desired, you may consider contacting a private attorney for advice.
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If your complaint involves a claim dispute of not more than $10,000, you may want to contact your county's small claims court.