§ 27-8-28-19 — Grievance procedure filing; complaint analysis and reporting

Indiana § 27-8-28-19

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 8: LIFE, ACCIDENT, AND HEALTH
• Ch. 28: Internal Grievance Procedures

Text

(a) An insurer shall each year file with the
commissioner a description of the grievance procedure of the insurer
established under this chapter, including:
(1) the total number of grievances handled through the procedure
during the preceding calendar year;
(2) a compilation of the causes underlying those grievances; and
(3) a summary of the final disposition of those grievances.
(b) The information required by subsection (a) must be filed with
the commissioner on or before March 1 of each year. The
commissioner shall:
(1) make the information required to be filed under this section
available to the public; and
(2) prepare an annual compilation of the data required under
subsection (a) that allows for comparative analysis.
(c) The commissioner may require any additional reports as are
necessary and appropriate for the commissioner to carry out the
commissioner's duties under this article.
(d) The commissioner shall do the following:
(1) Compile and analyze complaints received by the department
concerning a denial of coverage under an accident and sickness
insurance policy for:
(A) an investigational or experimental treatment; or
(B) a treatment not considered to be medically necessary for a
covered individual.
(2) If the commissioner determines that a pattern of denials of
coverage is evident through the analysis performed under
subdivision (1), report the pattern to the legislative council in an
electronic format under IC 5-14-6.
(3) Remove from a report made under subdivision (2) any
information that could be used to identify an individual.

Legislative History

As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13. Amended by P.L.18-2016, SEC.3.