If you are an Oregon resident and your claim is denied after the external review process, you can file a complaint with the Division.

Complaint information. Your complaint should include the following information:

  • The name, address, email address, and telephone number of the person filing the complaint (“Complainant”);
  • The names of other parties involved in the claim;
  • The name of insurance company;
  • The policy number, claim number, and date of loss;
  • The reason for the complaint;
  • The details of the complaint; and
  • What you consider to be a fair resolution.[12]

Supporting documents. You should submit the following supporting documents with your complaint:

  • A copy of your insurance card;
  • Copies of your determination letters from your insurer;
  • Copies of any determinations made by internal and external reviewers;
  • Any materials submitted with prior appeals and complaints;
  • Supporting documentation from your health care provider;
  • A copy of your insurance policy; and
  • All responses from your insurer.[13]

How to submit. The complaint may be submitted online here, faxed to (503) 378-4351, or mailed to the following address:

Department of Consumer & Business Services
Insurance Division
P.O. Box 14480
Salem, OR 97309-0405[14]