Wisconsinites may file a complaint with us when they are unable to resolve a dispute with an insurance company or agent, they have a problem with a pharmacy benefit manager service, or they receive a surprise medical bill.
Some examples of complaints we can help with include coverage issues, claim disputes, billing or premium issues, sales misrepresentations, and policy cancellations. OCI regulates the insurance industry within guidelines defined in state law and regulation. We are unable to act as a lawyer or give legal advice, make medical judgements, or determine who is at fault. We cannot establish the facts surrounding a claim – including deciding which party's position is more believable. We are also unable to determine the value of a claim, the amount owed to your constituent, or act as their claim adjuster. Overall, we cannot require a company to pay a claim, refund a premium, or reinstate or issue a policy unless there is clear documentation of a confirmed violation of Wisconsin insurance law or regulation.
If our office isn't the right place to resolve your constituent's concern, we will work to make sure your constituent's complaint goes to the correct place or they are directed to the appropriate next steps such as small claims court.