Online Insurance Complaint Submission

All fields denoted by button are required for your complaint to be submitted online.

button Name
button Address
button City
button State
button Zip Code
button Daytime Phone
button E-mail Address
button Insurance Company
For automobile complaints against another person's insurance company, list their company, NOT YOURS.
Agent's Name
Name of Insured
Policy Number
Claim Number
Date of Loss
Type of Coverage

button Authorization
Without otherwise waiving the confidentiality protection of Iowa Code §505.8 (Supp. 2003) Iowa code, I authorize the Iowa Insurance Division to provide a copy of this complaint form to the insurance company or insurance producer that is the subject of my complaint.
button Please state the reason for your complaint and the action you would like the Insurance Division to take:

Please Note: We will normally attempt to contact you via your email address (If entered on this form) regarding your submission.  We request that you would provide us with your phone number in the event that we are unable to contact you via email.

If you have a preferred method which to contact you (phone or email), please state this on your request.