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§27-57.1-1  Interception of insurance payments. –


Published: 2015

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TITLE 27

Insurance

CHAPTER 27-57.1

Medical Assistance Intercept Act

SECTION 27-57.1-1



   § 27-57.1-1  Interception of insurance

payments. –

(a) Every domestic insurer or insurance company authorized to issue policies of

liability insurance pursuant to this title, and also any workers' compensation

insurer, within thirty (30) days prior to the making of any payment equal to or

in excess of five hundred dollars ($500) to any claimant, for third party for

personal injury or workers' compensation benefits under a contract of

insurance, shall review information provided by the executive office of health

and human services pursuant to § 27-57.1-4, indicating whether the

claimant has received medical assistance in accordance with chapter 40-8.



   (b) If the insurer determines from the information provided

by the executive office of health and human services pursuant to §

27-57.1-4 that the claimant or payee has not received medical assistance, the

insurer may make the payment to the claimant in accordance with the contract of

the insurance.



   (c) If the insurer determines from the information provided

by the executive office of health and human services pursuant to §

27-57.1-4 that the claimant or payee has received medical assistance, the

insurer shall, except to the extent payments are subject to liens, written

notices, or interests described in § 27-57.1-3, withhold from payment the

amount to the extent of the distribution for medical assistance as a result of

the accident or loss, dating back to the date of the incident, pay that amount

to the executive office of health and human services and pay the balance to the

claimant or other persons entitled to it. The executive office of health and

human services shall provide written notice to the claimant and his or her

attorney, if any. The notice shall reflect the date, name, social security

number, case number, amount of the payment being withheld to reimburse the

state, reason for payment and opportunity to request a hearing as provided for

in subsection 27-57.1-1(e). Any insurer or insurance company, its directors,

agents, and employees and central reporting organizations and their respective

employees authorized by an insurer to act on its behalf that releases

information in accordance with the provisions of this chapter, or who withholds

an amount from payment based upon the latest information supplied by the

executive office of health and human services pursuant to § 27-57.1-4 and

disburses in accordance with § 27-57.1-3, shall be immune from any

liability to the claimant, payee lien holder, payee who provided written

notice, or security interest holder. Any withholding from payments in

accordance with this chapter and payment made to the executive office of health

and human services is further subject to the provisions of § 40-6-9,

regarding rights of assignment and subrogation by medical assistance

recipients. Said payments to the executive office of health and human services

shall be for reimbursement of distributed medical assistance incurred as a

result of the accident or loss, dating back to the date of the incident.



   (d) Workers' compensation claimants who receive medical

assistance, provided in accordance with chapter 40-8, shall be subject to the

provisions of this chapter. However, the workers' compensation reimbursement

payments made to the executive office of health and human services in

accordance with this chapter shall be limited to that set forth in chapter

28-33 and § 40-6-10.



   (e) Any claimant aggrieved by any action taken under this

section may within thirty (30) days of the mailing of the notice to the

claimant in subsection (c) of this section, request a hearing from the

executive office of health and human services. Any payments made by an insurer

pursuant to this chapter shall be made to the executive office of health and

human services, should there be no request for a hearing within thirty (30)

days of receipt of notice, or within ten (10) business days of a decision after

a hearing and in accordance with the decision of any hearing that takes place

as provided for in this subsection.



History of Section.

(P.L. 2012, ch. 241, art. 11, § 1.)