R590-192-5. File and Record Documentation

Each insurer's claim files are subject to examination by the commissioner. To aid in such examination:

(1) Sufficient detailed documentation shall be contained in each claim file in order to reconstruct the benefit determination, and the calculation of the claim settlement for each claim.

(2) Each document within the claim file shall be noted as to date received, date processed and notification date.

(3) The insurer shall maintain claim data that is accessible and retrievable for examination. An insurer shall be able to provide:

(a) the claim number;

(b) copy of all applicable forms;

(c) date of loss;

(d) date of claim receipt;

(e) date of benefit determination;

(f) date of settlement of the claim; and

(g) type of settlement indicated as:

(i) payment, including the amount paid;

(ii) settled without payment; or

(iii) denied.