Sec. 2213c.
(1) Each disability income insurer shall establish an internal grievance procedure for persons covered under a disability income policy, certificate, or contract.
(2) An internal grievance procedure under subsection (1) shall include all of the following:
(a) Provide for a designated person responsible for administering the grievance procedure.
(b) Provide for a designated person or telephone number for receiving grievances.
(c) Ensure full investigation of a grievance.
(d) Provide for timely notification to the insured as to the progress of an investigation.
(e) Provide for the insured to have the right to have the grievance reviewed by a managerial-level person or group.
(f) Provide for notification to the insured of the results of the insurer's investigation and, if the insurer upholds its prior determination on the grievance, for advising the insured of his or her right to present the grievance to the commissioner for review.
(g) Provide that a final determination will be made in writing by the insurer not later than 45 calendar days after a grievance is submitted in writing by the insured unless the insurer requires an extension of time to obtain additional information to make a determination with respect to the subject of the grievance. The extension may not exceed 45 days from the end of the initial period unless the initial period is extended due to the insured's failure to submit information necessary to decide the claim on appeal. If the extension is due to an insured's failure to submit information, the period for making the determination shall be tolled until the date the insured responds to the request for additional information.
(h) Provide for copies of all grievances and responses to be available at the principal office of the insurer for inspection by the commissioner for 2 years following the year the grievance was filed.
(3) As used in this section, “grievance” means a written complaint by an insured concerning the payment of benefits under a disability income insurance policy.
History: Add. 2002, Act 707, Imd. Eff. Dec. 30, 2002
Popular Name: Act 218
Last modified: October 10, 2016