For Patientís use notify the New York State Insurance Department of unfair claims settlement practice.
Note:† Enclose copy of claim forms and send copies to those listed below
Mr. Gregory Serio
Superintendent of Insurance
NYS Insurance Dept.
Empire State Plaza
Agency Building 1
Albany, NY 12257
Dear Mr. Serio:
My dentist submitted a claim for benefits on my behalf on DATE . A copy of my claim is enclosed. I have dental benefits provided by my employer, NAME, administered by the COMPANY NAME. When I did not receive my reimbursement, I phoned COMPANY on several occasions and have been repeatedly assured verbally that payment would be made before DATE. However, to date, COMPANY has not made payment for this claim in accordance with my benefit policy.
As New York State law requires reimbursement be made on a customerís behalf within 45 days, we are compelled to report this company to the NYS Insurance Department for unfair claims settlement practices, and seek the imposition of the penalties and interest permitted by New York State law as well.
cc: Dentistís Name
US Labor Dept,
Pension and Welfare Benefits Administration
200 Constitution Avenue NW
Washington, DC 20210
Att: Consumer Complaints Division
NYS Dental Association Council on Dental Benefit Programs
American Dental Association Council on Dental Benefit Programs