Before proceeding, you must read and sign our Authorization & Agreement for Dispute Resolution Services form.
If you prefer, a representative can act on your behalf. Also, in some cases, a representative may be acting on behalf of a deceased.
Representatives
If you are acting on behalf of someone for this complaint, you need to fill out the lines entitled “Name of Consumer’s Representative” and “Signature of Consumer’s Representative.” Once a representative is appointed, all our communications will only be with this person – and not with the owner of the policy or the group insurance plan member.
If the policy owner or the group plan member is deceased, you must give us proof that you are the executor of the estate. You can do this with a copy of the last will and testament or with other appropriate legal documentation.
We do not permit insurance agents/advisers, media, treating medical professionals or consumer advocates to act as the consumer representative due to potential conflicts of interest.
If you have any questions, please contact us.
To review the authorization form BEFORE signing it and submitting a complaint, click here.
If you are ready to proceed: Click the button that relates to your situation to be directed to the proper authorization form.
Note:
OLHI’s authorization form must be completely filled out, and electronically signed and dated by:
- the person who owns the insurance policy; or
- the person who is a member of the insurance plan through a job or association.
The lines entitled “Insurance Company (for OLHI use)” and “Insurance Company representative signature (for OLHI use)” must be left blank. OLHI will have this information completed by the insurance company.