Forward a copy of your complaint to the insurance company, if appropriate;
Obtain information or explanations on your behalf from the insurance company or their representatives. This may involve written and verbal contact with such companies or persons;
Review in detail the information obtained from the company for compliance with statutes, regulations and their own policy contracts;
In general, explain the language, provisions and coverages of your insurance policy;
Suggest to you actions or procedures that you may take which could aid in resolving your insurance problem;
If it is determined that the actions of an insurance company are in violation of a statute, regulation or policy that the Administration enforces, we may take corrective action against that company.
Assist with filing appeals relating to medical claims
Assist with open enrollment questions for both fully insured and self-funded policies issued in Delaware. **Marketplace enrollment issues are handled through the Federally Facilitated Marketplace at 1-800-318-2596.
Inquire as to the appropriateness of Workers’ Compensation rate filings and audits (see “Other Jurisdictions”, below, for Workers Comp claims).
WHAT WE CANNOT DO:
Assume the role as your legal representative, in or out of court;
Intervene in a pending lawsuit on your behalf;
Intervene in matters when an insurance policy (contract) was issued and delivered to the policyholder in another state (outside of Delaware);
Recommend or suggest doing business with specific insurance agents/brokers or companies