Complaint sample. PDF. Complaint fill in. PDF.You can file a complaint or grievance with your plan. In this post, we discuss the ERISA claim process, appealing your ERISA claim, filing an ERISA complaint, when to hire an attorney, and more. The Division of Human Rights complaint form is available at the below link. You may use this form to file and submit your complaint online. Our lawyers can help you win approval for your disability claim, long term care claim, or health insurance coverage for your medically necessary treatment. To file a complaint or to request a referral, please fill out this form and an OLPS representative will contact you. This ERISA procedure describes the general procedures of the department in issuing information letters and advisory opinions under the Act.