§ 27-8-29-17 — Reconsideration of resolution by insurer

Indiana § 27-8-29-17

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 8: LIFE, ACCIDENT, AND HEALTH
• Ch. 29: External Review of Grievances

Text

(a) If, at any time during an external review
performed under this chapter, the covered individual submits
information to the insurer that is relevant to the insurer's resolution of
the covered individual's appeal of a grievance decision under IC 27-8-28-17 and that was not considered by the insurer under IC 27-8-28:
(1) the insurer may reconsider the resolution under IC 27-8-28-17;
and
(2) if the insurer chooses to reconsider, the independent review
organization shall cease the external review process until the
reconsideration under subsection (b) is completed.
(b) An insurer reconsidering the resolution of an appeal of a
grievance decision due to the submission of information under
subsection (a) shall reconsider the resolution under IC 27-8-28-17
based on the information and notify the covered individual of the
insurer's decision:
(1) within seventy-two (72) hours after the information is
submitted, for a reconsideration related to an illness, a disease, a
condition, an injury, or a disability that would seriously jeopardize
the covered individual's:
(A) life or health; or
(B) ability to reach and maintain maximum function; or
(2) within fifteen (15) days after the information is submitted, for
a reconsideration not described in subdivision (1).
(c) If the decision reached under subsection (b) is adverse to the
covered individual, the covered individual may request that the
independent review organization resume the external review under this
chapter.
(d) If an insurer to which information is submitted under subsection
(a) chooses not to reconsider the insurer's resolution under IC 27-8-28-17, the insurer shall forward the submitted information to the
independent review organization not more than two (2) business days
after the insurer's receipt of the information.

Legislative History

As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14. Amended by P.L.1-2002, SEC.120.