WSR 13-12-079

PERMANENT RULES

OFFICE OF

INSURANCE COMMISSIONER

[ Insurance Commissioner Matter No. R 2013-05 -- Filed June 5, 2013, 11:23 a.m. , effective January 1, 2014 ]


Effective Date of Rule: January 1, 2014.

Purpose: WAC 284-30-360 and 284-30-650 require insurers, health care service contractors, and health maintenance organizations to respond in writing to the insurance commissioner regarding consumer complaints. The commissioner is amending these WAC sections to require that the response be submitted in an electronic format. This will allow these entities to transmit private information electronically in a secure method rather than by the use of "snail mail."

Citation of Existing Rules Affected by this Order: Amending WAC 284-30-360 and 284-30-650.

Statutory Authority for Adoption: RCW 48.02.060, 48.44.050, and 48.46.200.

Other Authority: RCW 48.30.010, 48.44.050, and 48.46.200.

Adopted under notice filed as WSR 13-10-078 on May 1, 2013.

A final cost-benefit analysis is available by contacting Jim Tompkins, P.O. Box 40258, Olympia, WA 98504-0258, phone (360) 725-7036, fax (360) 586-3109, e-mail rulescoordinator@oic.wa.gov.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 2, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 2, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 2, Repealed 0.

Date Adopted: June 5, 2013.

Mike Kreidler

Insurance Commissioner

OTS-5328.2


AMENDATORY SECTION(Amending Matter No. R 2007-08, filed 5/20/09, effective 8/21/09)

WAC 284-30-360   Standards for the insurer to acknowledge pertinent communications.   (1) Within ten working days after receiving notification of a claim under an individual insurance policy, or within fifteen working days with respect to claims arising under group insurance contracts, the insurer must acknowledge its receipt of the notice of claim.

(a) If payment is made within that period of time, ((acknowledgement)) acknowledgment by payment constitutes a satisfactory response.

(b) If an ((acknowledgement)) acknowledgment is made by means other than writing, an appropriate notation of the ((acknowledgement)) acknowledgment must be made in the claim file of the insurer describing how, when, and to whom the notice was made.

(c) Notification given to an agent of the insurer is notification to the insurer.

(2) Upon receipt of any inquiry from the commissioner concerning a complaint, every insurer must furnish the commissioner with an adequate response to the inquiry within fifteen working days after receipt of the commissioner's inquiry using the commissioner's electronic company complaint system.

(3) For all other pertinent communications from a claimant reasonably suggesting that a response is expected, an appropriate reply must be provided within ten working days for individual insurance policies, or fifteen working days with respect to communications arising under group insurance contracts.

(4) Upon receiving notification of a claim, every insurer must promptly provide necessary claim forms, instructions, and reasonable assistance so that first party claimants can comply with the policy conditions and the insurer's reasonable requirements. Compliance with this paragraph within the time limits specified in subsection (1) of this section constitutes compliance with that subsection.

[Statutory Authority: RCW 48.02.060 and 48.30.010. 09-11-129 (Matter No. R 2007-08), 284-30-360, filed 5/20/09, effective 8/21/09; 78-08-082 (Order R 78-3), 284-30-360, filed 7/27/78, effective 9/1/78.]


AMENDATORY SECTION(Amending Order R 87-5, filed 4/21/87)

WAC 284-30-650   Prompt responses required.   It is an unfair practice for an insurer, and a prohibited practice for a health care service contractor or a health maintenance organization, to fail to respond promptly to any inquiry from the insurance commissioner relative to the business of insurance. A lack of response within fifteen business days from receipt of an inquiry will be considered untimely. A response must be in writing((, unless otherwise indicated in the inquiry)) and submitted using the commissioner's electronic company complaint system.

[Statutory Authority: RCW 48.02.060, 48.44.050 and 48.46.200. 87-09-071 (Order R 87-5), 284-30-650, filed 4/21/87.]