If you are a Washington resident and your claim is denied after the external review process, you can file a complaint with the Washington Office of the Insurance Commissioner (“Office”).

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, address, email address, and telephone number of the insured individual, if different than the Complainant;
  • The name of insurance company;
  • Policy number, claim number, type of policy, and type of insurance;
  • The name, company name, address, and telephone number of the insurance adjuster;
  • Type of problem;
  • The details of the complaint; and
  • What you consider to be a fair resolution.[15]

Supporting documents. You should 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.[16]

How to submit. The complaint may be submitted online here, faxed to (360) 586-2018, or mailed to the following address:

Washington State Office of the Insurance Commissioner
P.O. Box 40255
Olympia, WA 98504-0255[17]