The Office of the Commissioner of Insurance assists complainants with their insurance problems. Links to the Insurance Complaint Form in pdf format are provided below. If you wish to use the fill and print form, see the instructions below. Please note that the fillable form cannot be sent to us as an e-mail attachment. You must print it after you fill it in and either mail it or fax it to us. You may also want to print a copy for your records. If you do not wish to use the fillable pdf form, click on the print version of the form, print it, and complete it as thoroughly as you can. An Adobe Reader 4.0 or higher is required for these forms which you can download at no cost from Adobe . Completed forms can be faxed to (608) 264-8115 or can be mailed to:

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.

Fill and Print Version--Insurance Complaint Form  (see instructions)

Print Version--Insurance 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 or send an e-mail message to ocicomplaints@wisconsin.gov.

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.