Washington Appeal Rights

Effective August 1, 2020, all adverse notifications must include the following statement:

“If you have questions or concerns about the actions of your insurance company or agent, or would like information on your rights to file an appeal, contact the Washington state Office of the Insurance Commissioner’s consumer protection hotline at 1-800-562-6900 or visit www.insurance.wa.gov. The insurance commissioner protects and educates insurance consumers, advances the public interest, and provides fair and efficient regulation of the insurance industry.”

An adverse notification is a notice, statement or document that describes one of more of the following:

• Claim denial;
• Final claim payment for less than the claim amount submitted;
• A determination that payment will not be made due to a utilization review determination, or that the procedure is experimental or not medically necessary; and
• Rescission, cancellation, termination or nonrenewal of a policy, unless initiated by the insured.