Perhaps you have filed a claim with your insurance company and have received no response. Or maybe your insurance company has denied a claim for a benefit to which you are entitled under the terms of your policy.  If you are being treated unfairly by an insurance company, it may be time to file a complaint with the South Dakota Division of Insurance.

The South Dakota Division Of Insurance

Insurance is primarily regulated at the state level. In South Dakota, the South Dakota Division of Insurance regulates and monitors insurance companies and agents operating in the state and protects consumers by making sure insurance providers are licensed, registered, and complying with state law.

The world of insurance is complex, and it is an unfortunate fact that insurance companies do not always treat their customers as they are required to. That is why part of the mission of the South Dakota Division of Insurance is to educate consumers and advocate for them. If you are having problems with an insurance company–including having a claim denied for benefits that you are owed–you can reach out to the Division to seek assistance or to file a complaint.

To file a complaint with the South Dakota Division of Insurance, just follow these three steps:

1. Try to resolve the complaint directly with the insurance company first.

Contact your insurance company first, because an issue can often be resolved more quickly by talking directly to the insurance company. If you have already spoken to one or more agents and have not received the service that you need, try requesting to speak to a supervisor. Also, if you are dealing with a health insurance company, you will have to go through the company’s internal appeals process before filing a complaint with the South Dakota Division of Insurance.

2. File a formal complaint.

If you are unable to reach a resolution with the insurance company, the next step is to file a formal complaint. To do so, fill out the online form using the Division’s complaint portal or download the form from the portal, fill it out, and submit it.  You may also submit a letter directly to the Division.

When filing your complaint, you will need to include the name of the insured person, the name of the insurance company or agent involved, information about the insurance policy (including the policy number, employer name or group number if applicable, and a copy of the insured person’s insurance card), a detailed description of the issue and the names of any particular persons who are involved, details of any correspondence between you and the insurance company about the issue, and a detailed explanation of the solution that you are seeking.

3. Allow the Division to investigate your complaint and reach a conclusion.

Once the South Dakota Division of Insurance has received your complaint, it will open an inquiry and assign your complaint a problem report identification number. You will receive this information in a letter from the Division.  

The Division will send a letter to your insurance company and request a response. South Dakota law gives an insurance company twenty days to respond to the Division after receiving the letter.

Once the Division receives this response, it will review the information provided and determine if more information is needed from the insurance company. One contact between the Division and the insurance company may not be sufficient, and the Division may request more information from the company. Each time it does so, the same twenty-day response period applies.  

After the Division has received all of the necessary information, it will review your complaint using state law, administrative rules, and the terms of your policy to determine if the insurance company has acted contrary to any law, rule, or term of your policy.  You will receive a letter from the Division informing you of the results once the investigation is complete.

Get the Legal Help You Need

The South Dakota Division of Insurance is a valuable resource for consumers. However, the Division cannot provide you with legal services or advice, nor can the Division become involved if your dispute with the insurance company is in litigation.  Sometimes a dispute with an insurance company requires the involvement of an experienced insurance attorney. Just letting your insurance company know that you have an attorney on your side ready to fight for your rights may be enough to partially or completely resolve the issue.

Also, insurance companies are legally obligated to act in good faith, which means that they are required to honor the terms of your policy and are prohibited from getting in the way of your receiving the benefits you deserve. If you believe your dispute was the result of bad faith on the part of your insurance company, you may want to speak to an insurance attorney about taking legal action on those grounds. In a claim for bad faith, you seek damages for the harm that you suffered as a result of the insurance company’s actions in addition to the benefits that you are entitled to under your policy.

For more information

You have rights under the law, including the right to be treated fairly by your insurance company. Contact Turbak Law Office at (866) 231-0914 to discuss your legal rights with a qualified and experienced South Dakota insurance attorney.