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Filing

DFS File #: Filing Dates: Enter date range, begin date only, or end date only. To search for a single date, enter the desired date in both fields. Submission Date: -

Complainant

Apellido/Nombre Comercial Nombre Dirección City, State Zip , Email Complainant Type: Asegurado Third Party Otros

Asegurado

Apellido/Nombre Comercial     Nombre   Policy # Claim #

Abogado

Apellido Nombre Initial Dirección City, State Zip , Email

Violation

Insurer Name Name of individual responsible for violation (if any):     Tipo de Seguro Accidente y Salud Life & Annuity Complemento de Medicare Automóviles Residential Property & Casualty Commercial Property & Casualty Responsabilidad Civil Profesional Misceláneos Otros Reason for Notice Cancelación Non-renewal Rechazo de la Reclamación Claim Delay Unsatisfactory Settlement Offer Unfair Trade Practice Otros    If other, specify:   Add Statutory provision(s) which the insurer allegedly violated. 624.155(1)(b)(1) 624.155(1)(b)(2) 624.155(1)(b)(3) 624.401(1) 624.401(2) 624.401(3) 624.401(4)(a) 624.401(4)(b)(1) 624.401(4)(b)(2) 624.401(4)(b)(3) 626.9541(1)(i)(1) 626.9541(1)(i)(2) 626.9541(1)(i)(3)(a) 626.9541(1)(i)(3)(b) 626.9541(1)(i)(3)(c) 626.9541(1)(i)(3)(d) 626.9541(1)(i)(3)(e) 626.9541(1)(i)(3)(f) 626.9541(1)(i)(3)(g) 626.9541(1)(i)(3)(h) 626.9541(1)(i)(3)(i) 626.9541(1)(i)(4) 626.9541(1)(o)(1) 626.9541(1)(o)(10) 626.9541(1)(o)(11) 626.9541(1)(o)(12) 626.9541(1)(o)(2) 626.9541(1)(o)(3)(a) 626.9541(1)(o)(3)(b)(I) 626.9541(1)(o)(3)(b)(II) 626.9541(1)(o)(3)(b)(III) 626.9541(1)(o)(3)(b)(IV) 626.9541(1)(o)(3)(b)(V) 626.9541(1)(o)(3)(b)(VI) 626.9541(1)(o)(3)(b)(VII) 626.9541(1)(o)(3)(b)(VIII) 626.9541(1)(o)(3)(c) 626.9541(1)(o)(4) 626.9541(1)(o)(5) 626.9541(1)(o)(6) 626.9541(1)(o)(7) 626.9541(1)(o)(8) 626.9541(1)(o)(9) 626.9541(1)(x)(1) 626.9541(1)(x)(2) 626.9541(1)(x)(3) 626.9541(1)(x)(4) 626.9541(1)(x)(5) 626.9541(1)(x)(6) 626.9551(1)(a) 626.9551(1)(b) 626.9551(1)(c) 626.9551(1)(d) 626.9551(2)(a) 626.9551(2)(b) 626.9551(2)(c) 626.9551(2)(d) 626.9551(4) 626.9705(1) 626.9705(2) 626.9706(1) 626.9706(2) 626.9707(1) 627.7283(1) 627.7283(2) 627.7283(3) 627.7283(4) 627.7283(5)   Add Specific policy language that is relevant to the violation. Enter all words or phrases (one at a time) that should be used to filter.   Add Facts and circumstances giving rise to the violation. Enter all words or phrases (one at a time) that should be used to filter.   Add