Ohio Department of Insurance Consumer Complaint Form

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Contact Information

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Insurance Information

 

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Complaint Description

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Complaint Reason(s)

Reason for Complaint - Select up to three (3) items *
Underwriting
Marketing & Sales
Claim Handling
Policyholder Service

Supporting Documentation (optional)

Note: This complaint form, all documents you send us, and any document received by our office as a result of handling your complaint may be a public record, subject to Ohio's Public Records Act. This law requires all public records to be available for inspection by anyone, upon request.

Warning: All documentation we receive will be imaged, then destroyed. Make copies of your documents and send the copies to us. Do not send original records.

Submit Complaint

To the best of my knowledge the above statement is correct. I understand that a copy of this form and any attachments may be sent to the insurance company or agent involved. I authorize the insurance company to release all of the medical records relating to this complaint to the Ohio Department of Insurance and I authorize the Ohio Department of Insurance to release medical records relating to this complaint to the insurance company or agent as necessary in order to resolve this complaint. I represent that I have the proper authority to execute this release.

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The State of Ohio is an Equal Opportunity Employer

Ohio Department of Insurance
50 W. Town Street, Third Floor - Suite 300
Columbus, Ohio  43215
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John Kasich, Governor | Mary Taylor, Lt. Governor / Director
General Info: 614-644-2658 | Consumer Hotline: 800-686-1526
Fraud Hotline: 800-686-1527 | OSHIIP Hotline: 800-686-1578
Version: 4.18.2