WARNING
Your browser JavaScript has been disabled. Please enable it before using this application !

Texas Department of Insurance

File Complaint Online

TDI uses information disclosed in this form to help resolve your complaint. Resolution may require TDI to share this information with the person or company named in your complaint. Although by law much of the information you submit may be considered public record, portions may be confidential. For example, you may include private information protected by the doctrine of common law privacy, medical records protected by the Medical Practice Act, or an e-mail address provided for the purpose of communicating electronically with TDI which is protected by the Texas Public Information Act. Sharing this information for purposes of processing your complaint does not waive these confidentiality protections. However, you may affirmatively consent to release of your e-mail address in response to a public information request or inquiry.

In addition, the Health Insurance Portability and Accountability Act (HIPAA) allows doctors and health care providers to provide information about a person´s health care to health oversight agencies such as TDI. The law permits doctors and providers to disclose this information without authorization if the disclosure is for any purpose for which the agency is legally authorized to collect information.

If you would like more information about the public or confidential nature of information maintained by TDI, please consult our Open Records Policy and our Web Site Privacy Policy.

This form is encrypted to meet privacy requirements.

Fields in bold are required.

  1. Physicians/ health care providers and their representatives filing the complaint must complete Attachment A
I. Complainant Contact Information













TDI may release my e-mail address in response to a public information request?








II. Insurance Policy Information

If the complainant is the policyholder, please go to III. Tell Us About Your Complaint.











III. Tell Us About Your Complaint



















Title Insurance Only


Workers´ Compensation Claim Only







HMOs or Group Health Only

























IV. Your Complaint


V. Resolution


VI. Submitting Your Complaint

Please submit insurance-related complaints by:

  • Mail:
    Texas Department of Insurance
    Consumer Protection (111-1A)
    P.O. Box 149091
    Austin, Texas 78714-9091
  • Fax: (512) 490-1007
  • Online. Print a copy for your records before clicking on the submit button.
  • Email: ConsumerProtection@tdi.texas.gov
  • In person or by delivery service:
    Texas Department of Insurance
    Consumer Protection (111-1A)
    333 Guadalupe St.
    Austin, Texas 78701

Submit complaints about a workers' compensation claim to the Division of Workers' Compensation by:

  • Mail:
    Texas Department of Insurance
    Division of Workers' Compensation, MS-8
    7551 Metro Center Drive, Ste 100
    Austin, Texas 78744
  • Fax: (512) 490-1030
  • Email: DWC-CRCSIntakeUnit@tdi.texas.gov

Tips for submitting supporting documentation:

  • Submit documentation within one day of filing your complaint.
  • Types of documentation that will help us resolve most complaints includes:
    • evidence that you paid for insurance (receipts, front and back copies of checks, billing statements, etc.)
    • certificates or other documents showing you had insurance coverage (copy of your policy, binder, ID/enrollment card, declaration page, plan description, etc.)
    • correspondence between you and your agent or insurance company (and/or any advertising) showing what you were told about your insurance coverage or your claims
    • evidence of unpaid claims (copies of unpaid bills or evidence that you have paid bills for which you seek reimbursement, accident/claim reports, etc.)
    • any other supporting documents that could help settle your complaint.
  • If you have a denial of claim or a slow claim payment issue, please attach each of the following items with your complaint:
    • the HCFA 1500 or the UB-92
    • evidence of claim submission
    • explanation of benefits (EOBs)
    • evidence of prior collecting activities and late payment, including mail receipts, copies of check stubs, and delivery confirmations (fax, postal, e-mail)
    • specific details regarding telephone and written communications with the insurance carrier, including names, dates and telephone numbers, if possible.

For questions or assistance with filing a complaint, call:

Consumer Help Line: 1-800-252-3439
Division of Workers´ Compensation 1-800-372-7713

VII. Authorization

AUTHORIZATION FOR THE TEXAS DEPARTMENT OF INSURANCE (TDI) TO DISCLOSE PROTECTED HEALTH INFORMATION OR OTHER CONFIDENTIAL INFORMATION

Please read this entire form before signing and complete all the sections that apply to your decisions relating to the disclosure of protected health information or other confidential information.


Covered entities, as that term is defined by Texas Health and Safety Code § 181.001, and including TDI, must obtain a signed authorization from the individual or the individual’s legally authorized representative to electronically disclose that individual’s protected health information. Authorization is not required for disclosures related to treatment, payment, health care operations, performing certain insurance functions, or as may be otherwise authorized by law.



   













TDI may release my e-mail address in response to a public information request?


I authorize the following to disclose the individual's protected health information or other confidential information:

Texas Department of Insurance
333 Guadalupe
Austin, TX 78701


Who can receive and use the health information or other confidential information?








Reason for disclosure

(Choose only one option below)








What information can be disclosed?

Complete the following by indicating those items that you want TDI to disclose. A minor patient must sign for the release of some of these items. If you authorize TDI to release all health information, then check only the first box.


Separately sign (please type) to indicate which of the following specific information TDI may release:





Effective time period. This authorization is valid until the earlier of the occurrence of the death of the individual; the individual reaching the age of majority; or permission is withdrawn; or the following specific date (optional):



Right to revoke: I understand that I can withdraw my permission at any time by giving written notice stating my intent to revoke this authorization to the person or organization or agency named under "WHO CAN RECEIVE AND USE THE HEALTH INFORMATION OR OTHER CONFIDENTIAL INFORMATION." I understand that withdrawing my permission will not affect prior actions taken in reliance on this authorization by entities that had permission to access my health information or other confidential information.

Signature Authorization: I have read this form and agree to the uses and disclosures of the information as described. I understand that refusing to sign this form does not stop disclosure of health information or other confidential that has occurred prior to revocation or that is otherwise permitted by law without my specific authorization or permission, including disclosures to covered entities as provided by Texas Health & Safety Code §181.154(c). I understand that information disclosed pursuant to this authorization may be subject to re-disclosure by the recipient and may no longer be protected by federal or state privacy laws.














If representative, specify relationship to the individual:









A minor individual must sign to authorize the release of certain types of information, including for example, the release of information related to certain types of reproductive care, sexually transmitted diseases, and drug, alcohol or substance abuse, and mental health treatment (see, for example, Texas Family Code §32.003).







  1. Physicians/ health care providers and their representatives filing the complaint must complete Attachment A
VIII. Access and Correction of Personal Information

With few exceptions, you are entitled to be informed about the information that the Texas Department of Insurance (TDI) collects about you. Under sections 552.021 and 552.023 of the Texas Government Code, you have a right to review or receive copies of information about yourself, including private information. However, TDI may withhold information for reasons other than to protect your right to privacy. Under section 559.004 of the Texas Government Code, you are entitled to request that TDI correct information that TDI has about you that is incorrect. For more information about the procedure and costs for obtaining information from TDI or about the procedure for correcting information kept by TDI, please email the of TDI´s Legal Services Division or review TDI´s Corrections Procedures.