If you are a South Carolina resident and your claim is denied after the external review process, you can file a complaint with the Consumer Services Division of the South Carolina Department of Insurance (“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 name and email address of the insured individual, if different than the Complainant;
  • The name and telephone number of insurance company;
  • The name and telephone number of the insurance adjuster or agent, if applicable;
  • The policy number, claim number, identification number, and date of loss;
  • The name of your employer, if applicable;
  • The type of insurance;
  • The reason for the complaint; and
  • The details of the complaint.[15]

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

  • A copy of your insurance card;
  • Copies of the 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 doctor;
  • A copy of your insurance policy; and
  • All responses from your insurer.[16]

The complaint may be submitted online here, faxed to (803) 737-6231, emailed to [email protected], or mailed to the following address:

Consumer Services Division
P.O. Box 100105
Columbia, SC 29202-3105[17]