Insurance DOI Complaint and Bad-Faith Demand — Wisconsin

Insurance DOI Complaint and Bad-Faith Demand (WISCONSIN)

Quick-Reference Summary

PART A — OCI COMPLAINT COVER LETTER

Sender Information

[CLAIMANT/INSURED FULL LEGAL NAME]
[Street Address]
[City, WI ZIP]
Telephone: [(___) ___-____]
Email: [____________________]

Date: [__/__/____]

VIA ONLINE PORTAL (PREFERRED) AND U.S. MAIL

Wisconsin Office of the Commissioner of Insurance
P.O. Box 7873
Madison, WI 53707-7873
Email: [email protected]
Fax: (608) 264-8115

Re: Consumer Complaint Against [INSURER NAME] — Failure to Timely Pay Claim Under Wis. Stat. § 628.46 and Violations of Wis. Admin. Code Ins. § 6.11

Dear Office of the Commissioner:

I submit this complaint against the above-identified insurer for failure to timely pay a Wisconsin insurance claim and for violations of Wis. Admin. Code Ins. § 6.11.

I. Factual Background

1. On [__/__/____], I [purchased/renewed] Policy No. [_______] issued by [INSURER] in Wisconsin. Exhibit A is the declarations page.

2. On [__/__/____], a covered loss occurred: [DETAILED DESCRIPTION].

3. On [__/__/____], I reported the loss and received Claim No. [_______]. Exhibit B is the proof of loss.

4. Claim handling chronology: [DATED CHRONOLOGY — adjuster names, inspections, communications, partial payments, denial date and basis].

II. Violations of Wisconsin Law

The carrier has violated one or more of the following:

☐ Wis. Stat. § 628.46(1) — Failure to pay the claim within 30 days after the insurer was furnished written notice of the fact of a covered loss and the amount of the loss. (The unpaid amount accrues 7.5% simple interest from the 31st day.)
☐ Wis. Admin. Code Ins. § 6.11(3)(a)1 — Misrepresenting pertinent facts or policy provisions.
☐ Wis. Admin. Code Ins. § 6.11(3)(a)2 — Failing to acknowledge with reasonable promptness pertinent communications.
☐ Wis. Admin. Code Ins. § 6.11(3)(a)3 — Failing to adopt and implement reasonable standards for prompt investigation.
☐ Wis. Admin. Code Ins. § 6.11(3)(a)4 — Not attempting in good faith to effectuate prompt, fair, and equitable settlement when liability has become reasonably clear.
☐ Wis. Admin. Code Ins. § 6.11(3)(a)5 — Compelling litigation by offering substantially less than amounts ultimately recovered.
☐ Wis. Admin. Code Ins. § 6.11(3)(a)6 — Refusing to pay claims without a reasonable investigation.
☐ Wis. Admin. Code Ins. § 6.11(3)(a)7 — Failing to affirm or deny coverage within a reasonable time after proof-of-loss completion.
☐ Wis. Admin. Code Ins. § 6.11(3)(a)8 — Failing to provide a reasonable explanation for denial or compromise.

Specific facts supporting each box checked: [PARTICULARIZED FACTS with adjuster names, dates, dollar amounts].

III. Relief Requested

I respectfully request that the Office:

1. Review the carrier's written response (due within 20 days plus mailing time);
2. Determine whether the carrier complied with Wisconsin law, regulations, and the policy;
3. Take appropriate administrative action if violations are found;
4. Provide me a copy of the carrier's response and the Office's findings; and
5. Refer the matter for market-conduct review if appropriate.

IV. Documents Attached

• Exhibit A — Policy declarations page
• Exhibit B — Proof of loss
• Exhibit C — Correspondence with carrier
• Exhibit D — Denial / low-ball offer letter
• Exhibit E — Repair estimates / appraisals / supporting documents
• Exhibit F — Completed OCI Consumer Complaint Form (51-005)

I understand that documents submitted may become public record.

Respectfully submitted,

___________________________________
[CLAIMANT FULL NAME]
Date: [__/__/____]

PART B — BAD-FAITH DEMAND LETTER TO CARRIER UNDER ANDERSON v. CONTINENTAL

Sender Letterhead

[CLAIMANT / COUNSEL NAME]
[Address]
[City, WI ZIP]
[Telephone] | [Email]

Date: [__/__/____]

VIA CERTIFIED MAIL, RETURN RECEIPT REQUESTED
Tracking No.: [____________________]
AND VIA FIRST-CLASS MAIL
AND VIA EMAIL TO [[email protected]]

[INSURER LEGAL NAME]
Attn: General Counsel and Senior Claims Officer
[Registered Agent Address — verify via https://www.wdfi.org/apps/CorpSearch/Search.aspx]
[City, State ZIP]

Cc: [Handling Adjuster Name and Address]; Wisconsin Office of the Commissioner of Insurance

Re: Demand for Payment and Notice of Common-Law First-Party Bad-Faith Claim Under Anderson v. Continental Ins. Co., 85 Wis. 2d 675 (1978); Statutory Interest Demand Under Wis. Stat. § 628.46

I. Notice and Purpose

This letter constitutes formal demand for payment of the above-identified Wisconsin insurance claim and notice of (a) the carrier's obligation to pay 7.5% statutory simple interest under Wis. Stat. § 628.46 and (b) a common-law first-party bad-faith claim under Anderson v. Continental Ins. Co., 85 Wis. 2d 675, 271 N.W.2d 368 (1978). The two remedies are independent. Anderson, 85 Wis. 2d at 691.

II. Insured–Insurer Relationship

[INSURER] issued Policy No. [_______] to Claimant effective [__/__/____]. The policy was in force on the date of loss with all premiums paid. The applicable coverage is [type]; the applicable limit is $[________].

III. Factual Basis and Written Notice of Loss Furnished

On [__/__/____], Claimant furnished the carrier with written notice of the fact of the covered loss AND the amount of the loss, triggering the 30-day payment clock under § 628.46. Specifically, Claimant submitted: [list documents and dates]. The carrier did not pay within 30 days; statutory simple interest at 7.5% per annum has accrued from [day 31].

[Continue with dated, particularized narrative of subsequent claim handling.]

IV. The Carrier Lacks a Reasonable Basis for Denial (Anderson Prong 1)

The carrier's [denial / under-payment / delay] is not supported by any reasonable basis:

1. Plain policy language covers the loss. [Cite specific provision; identify carrier's stated exclusion; explain why the exclusion does not apply.]

2. Investigation was inadequate or absent. [Specifics: failure to inspect; failure to obtain records; failure to interview; reliance on conclusory desk review.]

3. Departure from Wis. Admin. Code Ins. § 6.11. [Specific subsections violated.]

4. Contrary to controlling authority. [Cite Wisconsin appellate authority on point.]

V. Knowledge or Reckless Disregard (Anderson Prong 2)

The carrier knew, or recklessly disregarded the fact, that no reasonable basis supported its position:

• [Internal claim notes (obtained via OCI complaint or otherwise) showing pre-determined denial];
• [Adjuster statements demonstrating awareness of weakness in carrier's position];
• [Supervisor approval of denial despite contrary file evidence];
• [Failure to investigate facts that would have established coverage];
• [Pattern of similar conduct in OCI market-conduct examinations];
• [Carrier's own claim manual or guidelines contradicted by the denial].

Under Brethorst v. Allstate, 2011 WI 41, these facts constitute the "some evidence" of unreasonableness sufficient to support bad-faith discovery and trial.

VI. Damages

In addition, punitive damages are recoverable under Wis. Stat. § 895.043 on clear and convincing evidence of intentional disregard, capped at 2x compensatory damages or $200,000, whichever is greater.

VII. Demand for Relief — Thirty (30) Day Window

Claimant demands, within thirty (30) days of the carrier's receipt of this letter:

1. Payment of $[________] in unpaid policy benefits;
2. Payment of $[________] in accrued statutory interest under § 628.46;
3. Payment of $[________] in consequential damages;
4. Preservation of all claim notes, internal communications, vendor reports, claim manuals, reserve analyses, and bonus/incentive documentation (litigation hold demanded);
5. A signed release in mutually agreeable form upon payment.

Total settlement demand: $[________].

Failure to make a reasonable written tender will result in suit being filed for (i) breach of contract; (ii) statutory interest under § 628.46; and (iii) common-law first-party bad faith under Anderson, including punitive damages under § 895.043. A copy of this letter has been filed with the Wisconsin Office of the Commissioner of Insurance.

Respectfully,

___________________________________
[CLAIMANT / COUNSEL NAME]
[Title, if counsel]
WI State Bar No. [_____] (if counsel)

Enclosures: [Exhibits A–F as listed]

PART C — PRE-FILING CHECKLIST

Before Filing the OCI Complaint

☐ Confirmed policy was issued in or applies to Wisconsin.
☐ Confirmed claim is NOT under a self-funded ERISA plan, Medicare, BadgerCare Plus (WI Medicaid), or governed by another state's policy.
☐ Confirmed claim is NOT in active litigation (OCI declines).
☐ Gathered policy declarations page.
☐ Gathered proof of loss and chronology.
☐ Documented all adjuster communications.
☐ Identified specific § 628.46 violations and Wis. Admin. Code Ins. § 6.11 subsections.
☐ Completed signed OCI Form 51-005.
☐ Decided submission method: online (preferred) / U.S. mail / fax / email.
☐ Understood OCI complaint may become public record.
☐ Calendared 20-days-plus-mailing carrier response deadline.

Before Sending the Anderson Bad-Faith Demand

☐ Confirmed written notice of fact AND amount of loss furnished to carrier (start § 628.46 clock).
☐ Calculated day-31 interest accrual date.
☐ Identified specific Anderson Prong 1 facts (absence of reasonable basis).
☐ Identified specific Anderson Prong 2 facts (knowledge or reckless disregard).
☐ Gathered "some evidence" sufficient to survive Brethorst (claim notes, adjuster statements, pattern evidence, OCI documentation).
☐ Calendared 6-year tort limitations (Wis. Stat. § 893.93(1m)(a)) and 6-year contract limitations (§ 893.43).
☐ Verified registered agent at https://www.wdfi.org/apps/CorpSearch/Search.aspx.
☐ Letter sent certified mail RRR + first-class + email + OCI cc.
☐ Litigation-hold language included.
☐ Statutory interest computed correctly (7.5% simple, not compound).
☐ Demand quantified consequential damages and reserved punitive damages.

During the 30-Day Window

☐ Diary all responses, partial payments, and tenders.
☐ Update OCI complaint with any new violations.
☐ Preserve internal documentation.
☐ Re-compute interest as payments arrive.
☐ Confirm no third-party claimant issues (Kranzush bars third-party bad faith).

After the 30-Day Window

☐ File complaint in Wisconsin Circuit Court.
☐ Plead breach-of-contract count + § 628.46 statutory-interest count + Anderson bad-faith tort count.
☐ Plead punitive damages with Wis. Stat. § 895.043 specificity.
☐ Plead specific Wis. Admin. Code Ins. § 6.11 violations as evidence of absence of reasonable basis.
☐ Attach demand letter, certified mail receipt, and OCI response as exhibits.
☐ Anticipate Brethorst pleading challenge — front-load "some evidence" allegations.
☐ Preserve appeal/cross-claim issues if third-party situation (Kranzush bar).

SOURCES AND REFERENCES

Wisconsin Statutes

• Wis. Stat. § 628.46 — Timely Payment of Claims: https://docs.legis.wisconsin.gov/statutes/statutes/628/iii/46
• Wis. Stat. § 628.34 — Unfair Marketing Practices
• Wis. Stat. § 895.043 — Punitive Damages (cap: 2x compensatory or $200,000)
• Wis. Stat. § 893.93(1m)(a) — 6-Year Tort Limitations
• Wis. Stat. § 893.43 — 6-Year Written Contract Limitations
• Wis. Stat. § 807.01(4) — Settlement Offer Interest

Wisconsin Administrative Code

• Wis. Admin. Code Ins. § 6.11 — Insurance Claim Settlement Practices

Key Cases

• Anderson v. Continental Ins. Co., 85 Wis. 2d 675, 271 N.W.2d 368 (1978)
• Brethorst v. Allstate Prop. & Cas. Ins. Co., 2011 WI 41, 334 Wis. 2d 23, 798 N.W.2d 467
• Trinity Evangelical Lutheran Church v. Tower Ins. Co., 2003 WI 46, 261 Wis. 2d 333, 661 N.W.2d 789
• Kontowicz v. American Standard Ins. Co. of Wisconsin, 2006 WI 48, 290 Wis. 2d 302, 714 N.W.2d 105
• Kranzush v. Badger State Mut. Cas. Co., 103 Wis. 2d 56, 307 N.W.2d 256 (1981)
• Davis v. Allstate Ins. Co., 101 Wis. 2d 1, 303 N.W.2d 596 (1981)
• Upthegrove Hardware, Inc. v. Pennsylvania Lumbermans Mut. Ins. Co., 146 Wis. 2d 470, 431 N.W.2d 689 (Ct. App. 1988)

Wisconsin Office of the Commissioner of Insurance

• File a Complaint: https://oci.wi.gov/Pages/Consumers/Filing-a-Complaint.aspx
• Online Complaint Portal: https://ociaccess.oci.wi.gov/complaints/public/receiveComplaint
• Mail-In Complaint Form 51-005 (PDF): https://oci.wi.gov/Documents/OCIForms/51-005fillable.pdf
• Mailing: P.O. Box 7873, Madison, WI 53707-7873
• Overnight: 125 South Webster Street, Madison, WI 53703-3474
• Phone: 1-800-236-8517 (WI) / (608) 266-0103 (out-of-state)
• Email: [email protected]

Wisconsin Department of Financial Institutions (Registered Agent Search)

• https://www.wdfi.org/apps/CorpSearch/Search.aspx

Related Templates in This Repository

• /insurance_law/universal/time_limited_demand_bad_faith.md
• /insurance_law/universal/coverage_position_denial_response.md
• /insurance_law/jurisdictional/wi/bad_faith_demand_wi.md
• /insurance_law/jurisdictional/wi/insurance_claim_denial_appeal.md