Matthew Denn, Delaware's Insurance Commissioner

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Insurance Commissioner & Department of Insurance

Before you file a complaint or request with the Delaware Department of Insurance, you should first contact the insurance company, agent or adjuster in an effort to resolve the issue. If you do not receive a satisfactory response, then please complete this form. A copy of this complaint form may be provided to the insurance company, agent or adjuster.

Personal Information

First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone		Ext.
Home Phone
FAX
E-mail
Date of Birth

Policy Information

Type of insurance this complaint pertains to:

Auto
Homeowners
Life
Group Health
Individual Health
Commercial
Other

This complaint is about:

Insurance Company
Agent
Adjuster
Other

This complaint refers to a claim being filed through:

Your Policy
Someone Else's Policy

Insurance Company
Policy #
Claim #
State In Which Policy Was Purchased
Name of Person You Spoke To
Their Phone #
Date of Loss
Have You Retained a Lawyer?	Yes No
Is A Lawsuit Currently Ongoing or Pending?	Yes No
Nature of Complaint

Last Updated: Friday, 30-Mar-2007 12:42:24 EDT

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