Submit Online Complaint

Fill out the following form to submit your complaint to the Iowa Insurance Division. If you have not already read the section on How to File a Complaint, please do so before submitting your complaint.

Name: *

Address: *

Address 2:

City: *

State: *

Zip Code: *

County: *

Daytime Phone: *

###-###-####

Email Address: *

Insurance Company: *

For automobile complaints against another person's insurance company, be sure to list their company and not your own.

Agent's Name:

Name of Insured:

Policy Number:

Claim Number:

Date of Loss:

Type of Coverage:

Authorization: *

Authorization

Without otherwise waiving the confidentiality protection of Iowa Code §505.8 (2011), 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.

Reason for Complaint: *

Please state the reason for your complaint and the action you would like the Insurance Division to take.