The Official Website of the Attorney General of Massachusetts

Martha Coakley, Attorney General

Insurance/Financial Services Complaint Form


Office of the Attorney General
Insurance/Financial Services Division (IFSD)
One Ashburton Place
Boston, MA 02108

If your complaint is urgent or if you seek an accommodation due to a disability, please call the IFSD Hotline at 1-888-830-6277 or (617) 727-4765 TTY. Please note that all fields are required unless otherwise noted.

Your Contact Information:


  
  
  
  

(Example: 123-456-7890)
(NOTE: Please provide a working daytime telephone number.)
  
  
   
   
(Optional: You are not required to provide this information to file a complaint, but having it may help us serve you more effectively.)

Business or organization that is the subject of this complaint:


  
  
  
  

(Example: 123-456-7890)

  
  
  

(Example: 123-456-7890)

Information on your complaint:



(Note: 3000 characters maximum; 0 characters entered, 3000 characters remaining.)
 

 

(Note: 300 characters maximum; 0 characters entered, 300 characters remaining.)

 Yes  No

 
 Yes  No


 
 Yes  No
 
 Yes  No

Instructions:


DO NOT SEND ORIGINALS. Your documents will NOT be returned to you. Please retain a copy for your records and send us photocopies or an electronic scan of any documentation you think may be helpful in resolving the complaint.

Please do NOT include financial account numbers, credit or debit card numbers, your social security number, etc., or other sensitive personal information. We will contact you if we need any of this information.

Read the Following Before Signing Below:


I. Disclosure of Your Complaint.
Public Record. Under most circumstances, your complaint, and any documents submitted with your complaint, will be considered a public record and available to any member of the public upon request. In response to such a request, we generally will not disclose your name, address, phone number, or any other information that identifies you and will not disclose this form in response to any request that specifically seeks the complaint you submitted.
 
Disclosure to the Business or Organization. Do you authorize us to discuss your complaint with the company you are complaining about and any other parties that are related to your complaint?
 Yes  No
 
Disclosure to Other Entities. Your complaint and any related information may be disclosed in its entirety to other law enforcement and regulatory agencies.
 
II. Consulting With a Private Attorney.
The AGO cannot give you legal advice and is not able to be your private attorney, but represents the public interest. If you have any questions concerning your individual legal rights or responsibilities you should contact a private attorney.
 
 
By filling in my name above and checking this box, I acknowledge that I have read and understood the provisions above and certify that the information I have provided is true and correct to the best of my knowledge, and I adopt this as my online signature.