If you are a New Jersey resident and your insurer still denies your claim after the external review process, you can file a complaint with the Department.

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 of the insured individual, if different than the Complainant;
  • The name and address of the insurance company;
  • The policy number, claim number, and date of loss/claim;
  • The nature of the complaint;
  • The details of the complaint; and
  • The action requested.[17]

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

  • A copy of your insurance card;
  • Copies of coverage denials or 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.[18]

How to submit. The complaint may be submitted online here, faxed to (609) 454-8468, or mailed to the following address:

New Jersey Department of Banking and Insurance
Consumer Inquiry and Response Center
P.O. Box 471
Trenton, NJ 08625-0471[19]