§ 991.1111b. Prompt payment of clean claims
Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 40 P.S. InsuranceEffective: July 9, 2010
Effective: July 9, 2010
40 P.S. § 991.1111b
§ 991.1111b. Prompt payment of clean claims
(b) Within thirty (30) business days after receipt of the requested additional information, an insurer shall pay a claim for benefits under a long-term care insurance policy or certificate if it is a clean claim or send a written notice the insurer is declining to pay all or part of a claim and the specific reason or reasons for denial.
(c) If an insurer fails to comply with subsection (a) or (b), the insurer shall pay interest at the rate of one per centum (1%) per month on the amount of the claim that should have been paid but remains unpaid forty-five (45) business days after the receipt of the claim with respect to subsection (a) or all requested additional information with respect to subsection (b). The interest payable under this subsection shall be included in a late reimbursement without requiring the person who filed the original claim to make an additional claim for the interest.
(e) A violation of section 1111.11 or this section by an insurer if committed flagrantly and in conscious disregard of the provisions of this act or with frequency sufficient to constitute a general business practice shall be considered a violation of the act of July 22, 1974 (P.L. 589, No. 205),2 known as the “Unfair Insurance Practices Act.” A violation of section 1111.1 or this section is deemed an unfair method of competition and an unfair deceptive act or practice pursuant to the “Unfair Insurance Practices Act.”
“Claim” means a request for payment of benefits under a policy in effect regardless of whether the benefit claimed is covered under the policy or terms or conditions of the policy have been met.
“Clean claim” means a claim that has no defect or impropriety, including any lack of required substantiating documentation, such as satisfactory evidence of expenses incurred, or a particular circumstance requiring special treatment that prevents timely payment from being made on the claim.
Credits
1921, May 17, P.L. 682, No. 284, art. XI, § 1111.2, added 2010, July 9, P.L. 362, No. 51, § 8, imd. effective.
40 P.S. § 991.1111b, PA ST 40 P.S. § 991.1111b
Current through Act 10 of the 2024 Regular Session. Some statute sections may be more current, see credits for details.
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