{"id":1906,"date":"2026-05-08T14:15:16","date_gmt":"2026-05-08T18:15:16","guid":{"rendered":"https:\/\/oap.wp.vortexdev.com\/?page_id=1906"},"modified":"2026-05-26T11:09:13","modified_gmt":"2026-05-26T15:09:13","slug":"olhi-authorization-form","status":"publish","type":"page","link":"https:\/\/oap.wp.vortexdev.com\/en\/olhi-authorization-form\/","title":{"rendered":"Authorization Form"},"content":{"rendered":"\n

Before proceeding, you must read and sign our Authorization & Agreement for Dispute Resolution Services<\/em> form.<\/p>\n\n\n\n

If you prefer, a representative can act on your behalf. Also, in some cases, a representative may be acting on behalf of a deceased.<\/p>\n\n\n\n

\n\n\n\n
Representatives<\/h6>\n\n\n\n

If you are acting on behalf of someone for this complaint, you need to fill out the lines entitled \u201cName of Consumer\u2019s Representative\u201d and \u201cSignature of Consumer\u2019s Representative.\u201d Once a representative is appointed, all our communications will\u00a0only\u00a0<\/strong>be with this person \u2013 and not with the owner of the policy or the group insurance plan member.<\/p>\n\n\n\n

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.<\/p>\n\n\n\n

We do not permit insurance agents\/advisers, media, treating medical professionals or consumer advocates\u00a0to act as the consumer representative due to potential conflicts of interest.<\/p>\n\n\n\n

If you have any questions, please contact us<\/a>.<\/p>\n\n\n\n

\n\n\n\n

To review the authorization form BEFORE signing it and submitting a complaint, <\/strong>click here.<\/strong><\/a><\/p>\n\n\n\n

If you are ready to proceed<\/strong>: Click the button that relates to your situation to be directed to the proper authorization form.<\/p>\n\n\n\n

\n
\n
\n
I am submitting my own complaint<\/a><\/div>\n\n\n\n
I have a representative<\/a><\/div>\n<\/div>\n<\/div>\n\n\n\n
<\/div>\n<\/div>\n\n\n\n

Note:<\/p>\n\n\n\n

OLHI\u2019s authorization form must be completely filled out, and electronically signed and dated by:<\/p>\n\n\n\n

    \n
  • the person who owns the insurance policy; or<\/li>\n\n\n\n
  • the person who is a member of the insurance plan through a job or association.<\/li>\n<\/ul>\n\n\n\n

    The lines entitled \u201cInsurance Company (for OLHI use)\u201d and \u201cInsurance Company representative signature (for OLHI use)\u201d must be left blank. OLHI will have this information completed by the insurance company.<\/strong><\/p>\n\n\n\n

    <\/p>\n","protected":false},"excerpt":{"rendered":"

    Before proceeding, you must read and sign our Authorization & Agreement for Dispute Resolution Services form. If you prefer, a…<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-1906","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/oap.wp.vortexdev.com\/en\/wp-json\/wp\/v2\/pages\/1906","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/oap.wp.vortexdev.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/oap.wp.vortexdev.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/oap.wp.vortexdev.com\/en\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/oap.wp.vortexdev.com\/en\/wp-json\/wp\/v2\/comments?post=1906"}],"version-history":[{"count":8,"href":"https:\/\/oap.wp.vortexdev.com\/en\/wp-json\/wp\/v2\/pages\/1906\/revisions"}],"predecessor-version":[{"id":2515,"href":"https:\/\/oap.wp.vortexdev.com\/en\/wp-json\/wp\/v2\/pages\/1906\/revisions\/2515"}],"wp:attachment":[{"href":"https:\/\/oap.wp.vortexdev.com\/en\/wp-json\/wp\/v2\/media?parent=1906"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}