casualty insurers; claims
review
HB 2176 prohibits a casualty insurer from hiring a consultant for more than five per cent of the exams requested by the insurer. The bill also requires a consultant to disclose the amount of money he/she receives from casualty insurers and prohibits a consultant from receiving more than five per cent of his/her income from these examinations.
HB 2176 has a proposed strike-everything amendment.
The proposed strike-everything amendment requires all insurance companies that require an insured or claimant to undergo a medical or psychological examination to file an annual report with the Department of Insurance (DOI) regarding the physicians who performed the examinations.
Provisions
· Requires insurers who required one or more insureds or claimants to undergo a medical or psychological exam to file an annual report with DOI.
· Requires the following information to be disclosed in the insurers annual report:
1) number of exams requested by the insurer;
2) the name, number of exams, compensation and decisions of all providers or consultants who performed exams requested by the insurer.
· Requires that the information provided by the insurers include the number of times each provider or consultant concluded that any portion of an insured’s or claimant’s care by his/her treating health care provider was unnecessary, unreasonable or unrelated to the accident or illness claimed by the insured or claimant.
· Prohibits an insurer from providing claims personnel incentives (financial or otherwise) to challenge or deny claims.
· Prohibits an insurer from compensating a consultant on the basis of the amount by which a claim reviewed by the consultant was reduced.
HB 2176 failed to pass the Financial
Institutions and Insurance Committee.
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44th Legislature
Second Regular Session 2 March 7, 2001
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