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The Vermont Statutes Online
Title
08
:
Banking and Insurance
Chapter
154
:
LONG-TERM CARE INSURANCE
§
8093. Denial of claims; written explanation
(a) If a claim
under a long-term care insurance contract is denied, the issuer shall, within
60 days of the date of a written request by the policyholder or certificate
holder, or a representative thereof:
(1) provide a
written explanation of the reasons for the denial; and
(2) make
available all information directly related to the denial.
(b) After
completion of all internal appeals, the policyholder or certificate holder may
appeal the insurer's benefit trigger determination to an independent review
organization designated by the Commissioner, upon payment of a filing fee of no
more than $15.00. The filing fee may be waived or reduced upon a finding by the
Commissioner that the financial circumstances of the insured warrant a waiver
or reduction. All other costs of the independent review shall be paid by the
insurer. (Added 2003, No. 124 (Adj. Sess.), § 2, eff. Jan. 1, 2005; amended
2009, No. 137 (Adj. Sess.), § 28.)