44-1551. Financial exploitation; internal review; procedure; disbursement or transaction; delay; order for protective relief.

535 words·~2 min read·/ne/chapter-44/44-1551

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(1)If an insurer or trained individual reasonably believes a disbursement or transaction will likely result in or contribute to the financial exploitation of an eligible adult, the insurer or trained individual may initiate an internal review of the requested disbursement or transaction.

(2)An insurer may delay a disbursement or transaction from an eligible adult's insurance policy, contract, or account on which an eligible adult is a beneficiary if all of the following apply:

(a)The insurer reasonably believes, after an internal review is initiated pursuant to subsection

(1)of this section, that the requested disbursement or transaction will likely result in or contribute to the financial exploitation of an eligible adult;

(b)Immediately, but in no event more than seven business days after the disbursement or transaction is delayed, the insurer provides written notification of the delay and the reason for the delay to all persons authorized to transact business on the insurance policy, contract, or account. An insurer shall not notify a person authorized to transact business on the insurance policy, contract, or account if the insurer reasonably believes such person has committed or attempted financial exploitation or other abuse of an eligible adult or committed or attempted insurance fraud;

(c)Within seven business days after the disbursement or transaction is delayed, the insurer notifies the director of the delay and provides to the director the reason for the delay, including the status of the internal review initiated pursuant to subsection

(1)of this section; and

(d)The insurer continues the internal review of the suspected or attempted financial exploitation of the eligible adult, as necessary, and provides the director with updates of such review upon request.

(3)Any delay of a disbursement or transaction authorized by this section shall expire upon the first to occur of any of the following:

(a)A final determination by the insurer that the disbursement or transaction will not result in or contribute to financial exploitation of the eligible adult;

(b)Fifteen business days after the date on which the insurer first delayed the disbursement or transaction, unless extended pursuant to subdivision (3)(c) or (3)(d) of this section;

(c)If the internal review initiated pursuant to subsection

(1)of this section continues to support the insurer's reasonable belief that the disbursement or transaction will likely result in or contribute to the financial exploitation of an eligible adult, twenty-five business days after the date on which the insurer first delayed the disbursement or the transaction, unless extended pursuant to subdivision (3)(d) of this section; or

(d)If the internal review initiated pursuant to subsection

(1)of this section continues to support the insurer's reasonable belief that the disbursement or transaction will likely result in or contribute to the financial exploitation of an eligible adult, fifty-five business days after the date on which the insurer first delayed the disbursement or transaction.

(4)Notwithstanding subsection

(3)of this section, upon the petition of the director, an insurer who initiated a delay of disbursement or transaction pursuant to this section, or another interested party, a court of competent jurisdiction may enter an order terminating, extending, or modifying the delay of the disbursement or transaction and may order other protective relief.