58-3-7.4. Insurer's claim files subject to examination--File maintenance requirements.
211 words·~1 min read·
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Each insurer's claim files for policies or certificates are subject to examination pursuant to chapter 58-3 by the director of insurance. To aid in the examination:
(1)The insurer shall maintain claim data that is accessible and retrievable for examination. An insurer shall be able to provide the claim number, line of coverage, date of loss, and date of payment of the claim, date of denial, or date closed without payment. This claim data shall be available for all open and closed files for five years;
(2)Detailed documentation shall be contained in each claim file in order to permit reconstruction of the insurer's activities relative to each claim;
(3)Each relevant document within the claim file shall be noted as to date received, date processed, or date mailed. Dated correspondence is sufficient to document the date mailed for the purposes of this subdivision;
(4)For those insurers that do not maintain hard copy files, claim files shall be accessible from a computer, microfilm, Cathode Ray Tube (CRT), micrographics, or other similar electronic means and be capable of duplication to hard copy; and
(5)Claim information obtained in a telephone conversation or personal interview with any source which is used in the claim determination shall be documented in the claim file.