Services for Consumers
Filing A Complaint
Consumer Services can be reached at:
800-546-5664 (toll free in N.C.)
The Consumer Services Division of the North Carolina Department of Insurance aims to respond promptly, clearly and courteously to consumers’ insurance-related questions and complaints, assist consumers in resolving those complaints whenever possible, and help consumers understand their options for dealing with insurance-related matters.
Before deciding to file a complaint, please review the two sections below:
- "What We Can and Cannot Do"
- "Health Plans That We Do Not Regulate"
(if your concern is related to health coverage)
What We Can and Cannot Do
- Forward a copy of your complaint to your insurance company, and require the company to provide a response/explanation.
- Review the company’s response for compliance with applicable North Carolina statutes, regulations, and policy requirements.
- Require the company to take corrective action if we determine that the company’s position does not comply with applicable requirements.
- Help you understand your insurance policy.
- Recommend courses of action that you can take to resolve your problem, if we do not have the regulatory authority to resolve it ourselves.
- 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.
- Act as your legal representative in or out of court.
- Intervene in a pending lawsuit, on your behalf.
- Consult with you if you are represented by an attorney, unless we have your attorney’s written permission.
- Regarding a dispute between you and your insurance company, establish:
- Who was negligent or at fault.
- The value of a claim or the amount of money owed to you.
- The facts surrounding the claim (that is, who is being truthful when there are differing accounts of what happened).
- The facts regarding any other disagreement between you and another party.
- 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.
Health Plans That We Do Not Regulate
- State Health Plan for Teachers and State Employees
- Self-Funded Employee Health Benefit Plans, if you do not know whether your health plan is self-funded or if you are concerned about the legitimacy of the health plan in which you are currently enrolled, the NCDOI will address your concerns.
- Federal Employees’ Health Plan
- Inclusive Health
- Workers Compensation Claims or Requirement Questions
- Contact Information for Above Plans
File A Complaint