20-3153. Health care insurer liability
A. A health care insurer is liable for any damages caused to the insurer's enrollee by the insurer's delay in authorizing or failure to authorize a request for medically necessary health care services covered under the health care plan or by the insurer's denial of payment of benefits covered under the health care plan if both:
1. The health care insurer delayed authorizing or failed to authorize the requested health care services or denied payment of the covered benefits without a reasonable basis for that action.
2. The health care insurer knew that it acted without a reasonable basis or failed to perform an investigation or evaluation adequate to determine whether its action was supported by a reasonable basis.
B. A health care insurer:
1. Is liable under this section if the insurer's conduct was a cause of the enrollee's damages and if the damages would not have occurred without that conduct.
2. Is not liable under this section if the insurer's conduct under this section was inadvertent or unintentional.
Section: Previous 20-2903 20-2904 20-2905 20-3101 20-3102 20-3151 20-3152 20-3153 20-3154 20-3155 20-3201 20-3202 20-3203 20-3204 20-3205 NextLast modified: October 13, 2016