Ohio Department of Insurance Online Fraud Complaint Form

1) Enter information about suspect(s) here:
 
Suspect is
 
First name:
Middle name:
Last name:
 
 
 
Birth date:
 
or Age:
 
Street 1:
Phone:
()
Street 2:
City:
State:
Zip:
-
 
If you have more than one suspect to report, click this button after you have finished the entry for the previous suspect.
2) Please describe the activity you wish to report in the space below:
In which Ohio county did this occur?
Check this box if you are reporting anonymously
Tell us about yourself here (optional):
 
First name:
Middle name:
Last name:
Phone:
Email:
 
 
 
()
 
 
Street 1:
Street 2:
City:
State:
Zip:
-
 
Check this box only if you are reporting on behalf of an insurance company
Send us the data:

In order to submit this complaint, enter the characters you see in the image into the textbox below it, then click "Submit Record". If the image is unclear, click the image to generate a new set of characters.


 

  

The State of Ohio is an Equal Opportunity Employer

50 W. Town Street, Third Floor - Suite 300   Columbus, Ohio   43215
General Info: 614-644-2658  |  Consumer Hotline: 800-686-1526  |  Fraud Hotline: 800-686-1527  |  OSHIIP Hotline: 800-686-1578