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]