No. 27319: R590-192. Unfair Accident and Health and Income Replacement Claims Settlement Practices Rule

DAR File No.: 27319
Filed: 07/30/2004, 02:23
Received by: NL

 

NOTICE OF REVIEW AND STATEMENT OF CONTINUATION

Concise explanation of the particular statutory provisions under which the rule is enacted and how these provisions authorize or require the rule:

This rule is authorized via the following code sites: Section 31A-2-201 which empowers the commissioner to administer and enforce Title 31A and to make rules to implement the provisions of this title. Subsections 31A-2-202(4) and (6) require the prompt and accurate response to department inquiries as found in Section R590-192-11 of the rule. Subsection 31A-26-301(1) allows the commissioner to write a rule regarding the timely payment of claims, the kind of notice and proof of loss that will be used, the manner in which an insurer may deny a claim, and what interest rate may be charged on a late claim payment. Section R590-192-9 of the rule provides standards for the timely payment of claims, Section R590-192-7 outlines the requirements for the proof of loss, and Subsection R590-192-12(15) provides instructions on the payment of interest on a late claim payment. Section 31A-26-303(4) authorizes a rule to define unfair claims settlement practices or acts. Section R590-192-12 of the rule provides specific unfair methods, and deceptive acts and practices. Subsection 31A-21-312(5) relates to the promulgation of a proof and notice of loss. Sections R590-192-7 and R590-192-8 of the rule provides guidelines for notices and proof of loss.

 

Summary of written comments received during and since the last five-year review of the rule from interested persons supporting or opposing the rule:

April through June of 2003 the department had a hearing and comment period for proposed changes to this rule. We received about three comments. One we satisfied by making further changes to the rule and the other two were from the same association requesting the disability claim procedures be put in a separate section of the rule. After talking with the association, the department decided not to make further changes to the rule since this had not be an issue before. If it became an issue, then the department would make changes in the rule.

 

Reasoned justification for continuation of the rule, including reasons why the agency disagrees with comments in opposition to the rule, if any:

This rule is a major consumer protection regulation. It sets parameters and timelines for payments of health insurance claims, and therefore should be continued. It was last updated to conform with federal regulations in 2003.

 

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Insurance
Administration
Room 3110 STATE OFFICE BLDG
450 N MAIN ST
SALT LAKE CITY UT 84114-1201

 

Direct questions regarding this rule to:

Jilene Whitby at the above address, by phone at 801-538-3803, by FAX at 801-538-3829, or by Internet E-mail at [e-mail]

 

Authorized by:

Jilene Whitby, Information Specialist