§ 26.1-36-37.1 — Standard health insurance proof of loss form - Claim payment time limits

North Dakota § 26.1-36-37.1

• Jurisdiction: North Dakota
• Title 26.1: Insurance
• Ch. 26.1-36: Accident and Health Insurance

Text

limits.
The commissioner shall prescribe by rule a standard health insurance proof of loss and
claim form for use in filing proof of loss and a claim for all health care services. For purposes of
this section, "health care service" means any service included in providing an individual with
medical, dental, or hospital care or any service incident to providing medical, dental, or hospital
care as well as any service provided to prevent, alleviate, care, or heal human illness or injury.
After receipt of a health insurance proof of loss form, the insurer shall, within fifteen business
days, pay the claim or that portion of the claim that is not contested, deny the claim, or make an
initial request for additional information. If a claim or a portion of a claim is contested, the
insured or the insured's assignee must be notified in writing that the claim is contested and the
reasons for the contest. Nothing in this notification precludes the insurer from denying the claim
in whole or in part, for other reasons at a later date. Within fifteen business days of the receipt of
the information initially requested, the insurer shall pay or deny the claim.