Complaint Form North Carolina Insurance Commissioner

What They Can and Cannot Do

THEY CAN…

1. Forward a copy of your complaint to your insurance company, and require the company to provide a response/explanation.
2. Review the company’s response for compliance with applicable North Carolina statutes, regulations, and policy requirements.
3. Require the company to take corrective action if we determine that the company’s position does not comply with applicable requirements.
4. Help you understand your insurance policy.
5. Recommend courses of action that you can take to resolve your problem, if we do not have the regulatory authority to resolve it ourselves.
6. If your situation involves a health plan’s noncertification decision (denial based on lack of medical necessity), refer you to the Department of Insurance’s Healthcare Review Program (HCR Program), for further guidance.

THEY CANNOT…

1. Act as your legal representative in or out of court.
2. Intervene in a pending lawsuit, on your behalf.
3. Consult with you if you are represented by an attorney, unless we have your attorney’s written permission.
4. Regarding a dispute between you and your insurance company, establish:
   1. Who was negligent or at fault.
   2. The value of a claim or the amount of money owed to you.
   3. The facts surrounding the claim (that is, who is being truthful when there are differing accounts of what happened).
   4. The facts regarding any other disagreement between you and another party.
5. Address plans or companies that are not subject to the insurance laws of North Carolina, or that are governed by other state agencies (see “Health Plans that We Do Not Regulate”, below).

The North Carolina Department of Insurance pledges to seek fair treatment of all parties in insurance transactions. We are here to serve you.

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