Step 1 Making a Complaint   

On-line Complaint Form   

Step 2 Mediation   

Sample Letter for Written Request   

Sample letter - request for formal mediation

This is a sample letter of request for formal mediation with your insurance company. You do not have to use this letter, but please include the same elements: your address, name of your insurance company, a brief description of the case in dispute, the way you would like to see the case resolved, and a request to enter into mediation with your insurance company. Please attach the letter of final position from the insurance company and all other relevant documents that you want addressed in the mediation process.


Dear [Customer Services Officer handling your file],

Please be advised that I have exhausted all complaint resolution options with my insurance company, [include name of insurance company], regarding [include a brief description of the dispute].

I have attached my insurance company’s final letter of position regarding my complaint, and the proposed resolution is not to my satisfaction. I had hoped for [describe type of resolution you are seeking].

I would like to begin mediation with my insurance company to arrive at a more acceptable solution.


[Your name]

[Your address]


Insurance OmbudService - dispute resolution, conflict resolution and more from General Insurance OmbudService. Consumer mediation - conflict resolution, dispute resolution, Insurance ombudservice.