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- Complaint Summaries
Mission Statement
We are public servants, proudly making a difference in the lives of our citizens through advocacy, education, and exemplary service.
The Office of Consumer Services provides assistance to consumers on a wide range of insurance claim and policy issues. The Consumer Services staff responds to consumer needs relating to auto, health, homeowners, and life insurance; provides consumers with market assistance by helping to identify hard-to-place insurance coverage within the insurance market; and assists consumers following a catastrophic event.
File a Complaint
1. CONSIDER:
Before submitting your concerns to the South Carolina Department of Insurance, please review the following information:
•Please contact the insurance company and allow them the opportunity to resolve your issue.
•Most issues can be resolved within 30 days.
•State your concerns to the company’s representative.
•Provide the information they request (e.g., write a formal letter of complaint, file any specific forms, provide supporting documentation, etc.).
•Keep detailed records of all your communications with the insurance company.
•Gather and send the required documentation to the insurance company.
If you are unable to resolve your concerns with the insurance company or are not satisfied with their response, please proceed to Step 2.
2. VERIFY AND LEARN:
The SC DOI Can:
•Help you with insurance concerns involving companies that issue policies in South Carolina including property and casualty, health, life, annuity, disability, long-term care, bail bonds, title insurance companies, and more. We can also assist you with issues concerning agents and agencies. Examples include coverage issues, claim disputes, premium issues, policy cancellations or non-renewals, refunds, and sales misrepresentations.
•Contact the insurance company or agent/agency and require them to provide an explanation for their actions. By statute, insurance entities have 7 days to respond to the SC DOI. We strive to resolve the issue within 7-10 days.
•Review in detail the information obtained from the company’s response to determine compliance with applicable South Carolina statutes, regulations, and policy contracts.
•Help you understand your insurance policy.
•Recommend places you can go for help if we do not have the authority to resolve your issues.
3. GATHER:
To help ensure that we receive all the necessary information to investigate your submission, please provide us with the following:
•The exact name of the insurance company.
•The full name of any agent or adjuster who may be involved.
•Your policy number, claim number, and the date of your loss, if applicable.
•A detailed description of your concerns.
•Copies of supporting documentation.
•Before submitting your formal complaint, please read the following disclosures:
Important Complaint Disclosures
Important Note for Consumers Represented by Third-Parties
The following parties must submit written authorization or the appropriate legal documents signed by the insured or policyholder:
• Power of Attorney (POA)
• Executors of an Estate
• Court-appointed representatives, Consumer Advocates
• Contractors, third-party vendors, and public adjusters
• Attorneys or Legal Representatives (Letter of Representation or Letter of Authorization required)
If you are a third party representing the insured, please provide a signed authorization or agreement that clearly states the insured’s consent for you to act on their behalf regarding the subject regulatory complaint.
If an attorney is representing you in this matter, we will need written authorization from your attorney in order for us to intervene in this matter. You may have your attorney co-sign the form or include a signed letter of authorization that is on the attorney’s letterhead with the form.
Submit Your Formal Complaint
Once you have gathered the required materials and documentation, you are ready to submit your formal complaint:
- Online Consumer Complaint Form
- Consumer Complaint Form (PDF Version)
Rebuttal Process
If you disagree with the company’s initial response to your SC DOI complaint, you may submit one rebuttal to the Department for review.
To prevent duplication, please do not submit a new online complaint form.
The SC DOI Does Not Regulate:
Large Employer Health Plans
If your employer's headquarters are not located in the State of South Carolina, contact the U.S. Department of Labor (USDOL), which regulates group employer self-funded health plans.
https://www.dol.gov/agencies/ebsa/about-ebsa/ask-a-question/ask-ebsa
Call: 1-866-444-3272
Medicare, Medicare Advantage, & Medicare Drug Prescription Plans
Medicare Parts A-D & Medicare Advantage plans are under the Federal oversight of the Centers for Medicare and Medicaid Services (CMS). This entity ultimately has the authority to help resolve matters concerning Medicare Parts A-D & Medicare Advantage. In general, this oversight includes credentialing/contracting issues, as well as complaints involving claims for Medicare Beneficiaries & Providers.
https://www.cms.gov/medicare/medicare
Call: 1-800-Medicare (1-800-633-4227)
Medicaid/Healthy Connections
Healthy Connections is South Carolina's Medicaid program. It is a medical assistance program that helps pay for some or all medical bills for many people who cannot afford medical care. The program also assists individuals who are over 65 or have a disability with the costs of nursing facility care and other medical expenses. Eligibility is usually based on the applicant’s income and assets. Healthy Connections is administered by the South Carolina Department of Health and Human Services (SCDHHS) and pays medical bills with state and federal tax money.
https://www.scdhhs.gov/Getting-Started
Call: 1-888-549-0820
State Health Plan/PEBA
As a self-funded entity, the State Health Plan and the plan’s fiduciary, Public Employee Benefit Authority-PEBA, are not under the regulatory authority of the SC DOI. Contact South Carolina Public Employee Benefit Authority- PEBA:
Call: 1-803-737-6800
Federal Employee Health Benefits (FEHB) Program
The FEHB program is regulated by the Federal Government through the U.S. Office of Personnel Management (OPM).
Call: 202-606-1800
TRICARE
TRICARE is the uniformed services health care program for active-duty service members (ADSMs), active-duty family members (ADFMs), National Guard and Reserve members and their family members, retirees and retiree family members, survivors, and certain former spouses worldwide.
https://www.tricare.mil/ContactUs
Call: 1-800-444-5445
Policies Purchased in Another State
If your issue does not involve an insurance policy purchased in South Carolina, please contact the appropriate state's department of insurance for assistance.
Workers' Compensation:
Claim Disputes/Benefit Issues: Contact SC Workers' Compensation Commission
803-737-5700
Workers' Compensation:
Class Code Issues- National Council on Compensation Insurance- NCCI
https://www.ncci.com/pages/default.aspx
800-NCCI-123 (800-622-4123)
*The department can assist with Workers' Compensation Rates & Forms issues.
As a regulatory agency, the South Carolina Department of Insurance (SCDOI) operates under the provisions of Title 38 of the South Carolina Code of Laws. Our role is to ensure that the insurance entities we regulate comply with applicable laws.
Please note:
We do not regulate customer service issues.
We do not regulate contractor/manufacturer standards or enforce building codes.
We have no authority to resolve civil, factual or contractual (policy) disputes.
We do not make underwriting or claim judgements.
We have no authority to compel the payment of any claim.
We have no authority to negotiate any settlement.
We cannot determine liability or negligence.
The Department is not a collection agency for body shops, service providers, contractors or other parties who are not the insured, and there is no provision in SC Law that authorizes this agency to pursue collection efforts on behalf of parties who are not the insured.
The only collection efforts we can pursue are civil fines imposed by this agency and to assist when there is an unpaid judgment.
Any fines imposed on an insurer are regulatory in nature and do not provide direct financial compensation to complainants.
Our authority extends only to individuals and entities we license and to policies incepted in South Carolina.
One of the primary missions of the South Carolina Department of Insurance is to serve and protect the insurance consumer. To fulfill that mission, the South Carolina Department of Insurance provides the valuable service of working with consumers and insurers to address consumer complaints. Complaints provide a great deal of information about the industry, individual insurers, and real-time consumer concerns, including emerging issues in the marketplace. The complaints received by the Department are analyzed, recorded, and tracked. The South Carolina Department combines the yearly complaint activity for consumers in the Consumer Complaint Summary.
The Consumer Complaint Summary is an annual report that provides a list of companies with more than $100,000 in written premium by line of business, the total number of complaints received by our Department, the number of confirmed complaints analyzed by our Department, the confirmed complaints as a percentage of total complaints, and the U.S. Market Share. If you have questions regarding a company not listed, please contact the South Carolina Department of Insurance.
Consumer Complaint Summary Definitions:
A complaint is defined as any written communication that expresses dissatisfaction with a specific person or entity subject to regulation under the state’s insurance laws. An oral communication, which is subsequently converted to a written form, will meet the definition of complaint for this purpose.
A confirmed complaint is defined as a complaint where insurers, licensees, producers, or other regulated entities committed any violation of:
- An applicable state insurance law or regulation;
- A federal requirement that the state department of insurance has the authority to enforce
- The term/condition of an insurance policy or certificate
- The complaint and entity’s response, considered together, indicate that the entity was in error. The determination as to whether a complaint is confirmed or not is made as a part of the analysis of the complaint filed by the SCDOI Office of Consumer Services staff.
Confirmed Complaints as a % of Total Complaints is the Confirmed Complaints divided by the Total Complaints, then multiplied by 100.
U.S. Market Share is calculated as the premiums or the number of policies written nationwide for the company divided by the total of premiums or the number of policies written nationwide. The market share assists the consumer in identifying the companies with the most impact on the market and the degree of competition in the market.
When shopping for an insurance policy one factor you may wish to consider is how one company’s number of complaints relates to those of other similarly sized companies. However, remember this is only one of the factors to consider when selecting a company to provide your insurance needs.
The following links provide the Complaint Summaries by type of coverage:
Auto Insurance | Homeowner's Insurance | Title Insurance | Workers Comp Insurance
Group Accident & Health Insurance | Individual Accident & Health Insurance | Group Annuity Insurance
Individual Annuity Insurance | Group Life Insurance | Individual Life Insurance
The SCDOI’s Office of Consumer Services can help answer your questions.
Email: consumers@doi.sc.gov │ Call: 803-737-6180│ Toll-Free: 1-800-768-3467
Mon -Fri 8:30 a.m. - 5:00 p.m.
If you would like to report suspected insurance fraud, please visit our Fraud Division page.