DEPARTMENT OF INSURANCE

Required Information

PLEASE NOTE: DUE TO PRIVACY AND HIPAA CONCERNS, COMPLAINTS CONTAINING MORE THAN ONE INDIVIDUAL INSURED PERSON WILL BE SUBJECT TO IMMEDIATE CLOSURE.

Before submitting your request to the Consumer Protection Division, please make sure you have the following information available:

Full name of the insurance company involved.
Your policy numbers.
Claim number (if any).
The following document(s) may be necessary to investigate your complaint in a timely manner and can be uploaded when completing form.
- If the person you are filing on behalf of is 18 years or older, you must include authorization to act on their behalf (Third Party Authorization or Power of attorney or Guardianship papers).
  To download the Third Party Authorization form, click the link Third Party Authorization.
- If the person you are filing on behalf of is deceased, please provide either Executor/Executrix or Proof of Beneficiary.
- For Health / Dental / Vision / Prescription complaints, provide a copy of all Insurance Cards (front & back).
A detailed explanation of your concerns.
Please check your policy to ensure that you are providing us with the correct name of your insurance company when submitting your Service Request. If the company information you submit is incorrect, it may impact the timeliness of the company’s response to the Department of Insurance. Pursuant to KRS 304.2-165, Kentucky Statutes, insurance companies are allowed 15 days to respond to the department. However, if the company information is incorrect, it may extend that response date.
It is our goal to resolve all complaints in 30 days. However, some complaints may require additional time. Should you have any questions or supplemental information regarding your complaint, please contact us at doi.consumercomplaints@ky.gov.

If you have questions or need assistance completing the on-line complaint form, please call (502) 564-6034 for further assistance.

Required Information

Complaint Information