Ohio Department of Insurance Online Fraud Complaint Form

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Contact Information
Company Name:
Contact Information
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Subject Information
 
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Entered Subjects:
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Subject(s) Information:
Insurance/Claims Information
ALLEGATION Claims
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Loss Amount: Fraudulent Amount:
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Claim Summary:
Type the name of the insurance company in the field below and select the proper company once its name appears. If a company name does not appear, or you are unsure as to which company you should select, please provide the name of the company in the complaint description section.
Company Name:
NAIC Code:
Policy Number:
Insurance Type:
Claim #:
Loss Amount Range: $
Billed Amount: $
Address
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Street:
City:
Other Address Explanation:
Medical
Service Description:
Procedure Type Code:

Begin Date:
Claim Status
Claim Status:
Settlement Amount: $
Paid Out Amount: $
Insurance/Claims Information:
Complaint Description

Note: When entering your complaint, please provide as much detail as possible so the Department can clearly assess the situation represented.

Complaint Description:
Supporting Documents (OPTIONAL)
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The following file types may be uploaded as attachments:
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Supporting Documents:
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Reference number:

Thank you for contacting the Ohio Department of Insurance ("Department") Fraud Unit.

The Department appreciates your willingness to report suspected fraud as insurance fraud impacts all Ohioans in the form
of higher insurance premiums. Sometime in the future, a Department investigator may contact you to request additional information regarding the matter reported.

Please understand that Department investigations and the records pertaining to those investigations are confidential by law.
Consequently, the Department will not be able to confirm if an investigation was opened regarding the matter you reported
or provide the status of any investigation initiated.

Thank you again for bringing this matter to our attention.

Sincerely,
The Ohio Department of Insurance Fraud Unit
50 W. Town Street, Suite 300
Columbus, OH 43220
614-644-2560 (Direct Line)
614-387-0115 (Fax)

To submit your complaint and supporting documentation to the ODI Fraud Unit, please click the button below:
Version: 5.1.50