Who should I call if I have any questions about filing a complaint?

You can contact the West Virginia Offices of the Insurance Commissioner at (888) 879-9842.  The Offices are open from 8:00 a.m. to 5:00 p.m., Monday through Friday.

What happens after the Office receives my complaint?

Once the Division receives your complaint, it will assign it to an insurance specialist who will send an acknowledgement letter to you. It will contact the insurance company, who then has 15 working days to respond. After the response is...

How do I file a complaint?

If you are a West Virginia resident and your insurer denies your coverage after the external review process, you can file a complaint with the West Virginia Offices of the Insurance Commissioner Consumer Services Division (“Division”). Complaint information. You can find...

How long will the external review process take?

The external review process should take no more than 45 days after the Offices of the Insurance Commissioner receives your request.[12] If you request an expedited external review, the process should no longer than 72 hours after your request is received.[13]

How do I request an external review?

You should submit your request for external review to the West Virginia Offices of the Insurance Commissioner (“Offices”) within 180 days from when your insurer sent you the final decision.[7] You can find a copy of the Independent External Review of...

In what circumstances can I apply for an external review?

During an external review, an independent third party reviews your insurer’s decision.[3] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. Under West Virginia law, you are entitled to request an...

How long should the internal appeals process take?

The internal appeals process should take a maximum of 30 days if you have not yet received the requested service or treatment and a maximum of 60 days if you have received the service or treatment but are waiting for...

How do I request an internal appeal?

If your insurer denies your claim, you have the right to an internal appeal.[1] This means you can ask your insurer to conduct a full and fair review of its decision. To appeal the denial, you should do the following: Review...

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