If you are a Delaware resident and your insurer denies your coverage after the external review process, you can file a complaint with the Delaware Department of Insurance (“Department”).

Complaint information. Your complaint should include the following information:

  • The name, age, address, email address, and telephone number of the person filing the complaint (“Complainant”);
  • The name of the insured individual, if different from the Complainant;
  • The names of any other parties involved in the claim (for example, the plan administrator);
  • The name of insurance company and the type of insurance;
  • The policy number, certificate number, claim number, date of loss or service, and reason for the complaint;
  • What you consider to be a fair resolution.

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

  • A copy of your insurance card;
  • Copies of coverage denials or adverse benefit determinations 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.[11]

How to submit. You can complete and submit a complaint online here. If you submit an online application, you should electronically attach supporting documents to the online complaint. Alternatively, the complaint and supporting documents can be faxed to (302) 739-6278 or mailed to:

Delaware Department of Insurance
Consumer Services Division
841 Silver Lake Blvd.
Dover, DE 19904[12]