§8093. Denial of claims; written explanation

Link to law: http://legislature.vermont.gov/statutes/section/08/154/08093
Published: 2015

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The Vermont Statutes Online



Banking and 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.)