Instructions

1. Choose one of the links listed in the Options for Filing a Complaint.
2. If you wish to send supporting documents along with your complaint, please do not use the on-line form and instead use one of the other options listed.
3. All fields with an asterisk (*) are required.
4. You must agree to the Consent to Release Information.
5. You have one hour to complete the on-line complaint form before the session times out.
6. Please note that the information you send us is not necessarily secure against interception. Therefore, please do not send us any sensitive information like your Social Security Number or date of birth in the description of your complaint. If you must provide us with such information contact us in writing by U.S. Postal Mail.

Options for Filing a Complaint

• You may submit a complaint on-line. Use this option when you do not need to include any attachments with the complaint. On-line Complaint Form
• You may complete the complaint form on-line, print it, and either mail it or fax it to us. Use this option when sending attachments. Fill and Print Complaint Form  (see instructions)
  Once completed, print the completed form. You may want to print a copy for your records. Press the Reset Form button at the top right corner of page 1 of the form to clear the form.
• You may print the complaint form, type or print clearly with a black pen, and mail it or fax it to us. Use this option when sending attachments. Mail Only Complaint Form

If you have any questions or problems printing or opening the forms above, call the complaints and information toll-free number at 1-800-236-8517 (within Wisconsin) or 1-608-266-0103 (outside of Wisconsin) or send an e-mail message to ocicomplaints@wisconsin.gov.

What You Should Know Before Filing a Complaint

The Office of the Commissioner of Insurance assists complainants with their insurance problems. A copy of your complaint will be sent to the company or agent with a request to respond directly to you and to advise our office of the action taken. You should hear from the company or agent in about 25 days from the date you send us your complaint. When we receive the information from the company or agent, we will review the file to determine what action we can take. We will notify you of our determination. If our office is unable to obtain the resolution you desired, you may consider contacting a private attorney for advice. If your complaint involved a claim dispute, you may want to contact your county's small claims court.

Please be advised that under Wisconsin's Open Records Law all information you provide may become a public record once the file is closed. Only actual medical records obtained from a health care provider are confidential under s. 146.82, Wis. Stat. As a result, you should omit or mark out any confidential or personal information such as Social Security Numbers prior to submitting it to our office.

How to use fillable pdf forms:

1. Click the link for the fill and print version of the insurance complaint form above.
2. Select the Hand tool if it is not already selected.
3. Click in the first fillable field.
4. Use the mouse to select (click on) a specific field or use the Tab key to move through the fields. Shift + Tab will go to the previous field.
5. Use the space bar or click the mouse button to mark or unmark a box.
6. For forms containing more than one page, use the scroll bar at the right to move from page to page or click the next page button in the status bar at the bottom of the form to advance to the next page.
7. Once completed, print the completed form. You may want to print a copy for your records.
8. Press the Reset Form button at the top right corner of page 1 of the form to clear the form.