20-3151. Definitions For the purposes of this section: 1. " Enrollee" means an individual who is enrolled in a health care plan provided by a health care insurer. 2. " Health care insurer" means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation, medical service corporation or hospital […]
20-3152. Exemptions; waiver A. This chapter does not create: 1. Any liability on the part of any employer or employer group purchasing organization that purchases coverage or assumes risk on behalf of its employees or on behalf of self-funded employee benefit plans. 2. Any new or additional liability on the part of a health care […]
20-3153. Health care insurer liability A. A health care insurer is liable for any damages caused to the insurer’s enrollee by the insurer’s delay in authorizing or failure to authorize a request for medically necessary health care services covered under the health care plan or by the insurer’s denial of payment of benefits covered under […]
20-3154. Health care appeals; admissibility In an action under this chapter, any person, enrollee or health care insurer may introduce into evidence for any purpose any of the documents, findings, decisions or information concerning events that occurred in the health care appeals process pursuant to chapter 15, article 2 of this title. The fact that […]
20-3155. Notice of intent to file suit A. Before an enrollee files an action pursuant to section 20-3153, the enrollee shall either: 1. Complete the health care appeals process prescribed in chapter 15, article 2 of this title. 2. Provide written notice to the health care insurer at least thirty days before filing suit stating […]
