31A-21-314. Prohibited provisions.

278 words·~1 min read·/ut/title-31a/chapter-21/31a-21-314

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

Effective 5/8/2018

(1)As used in this section:

(a)"Reserving discretionary authority" means a policy provision that:

(i)has the effect of conferring discretion on an insurer, or other claim administrator, to:

(A)determine eligibility for benefits; or

(B)interpret the terms or provisions of the policy, contract, certificate, or agreement; and

(ii)could lead to a deferential standard of review by a reviewing court.

(b)"Reserving discretionary authority" does not include a policy provision that:

(i)informs an insured that, as part of the insurer's routine operations, the insurer applies the terms of the contract for:

(A)making a decision, including making a determination regarding eligibility, or receipt of benefits or claims; or

(B)explaining the insurer's policies and procedures; and

(ii)does not give rise to a deferential standard of review by a reviewing court.

(2)An insurance policy subject to this chapter may not contain a provision:

(a)requiring the insurance policy to be construed according to the laws of another jurisdiction except as necessary to meet the requirements of compulsory insurance laws of other jurisdictions;

(b)depriving Utah courts of jurisdiction over an action against the insurer, except as provided in permissible arbitration provisions;

(c)limiting the right of action against the insurer to less than three years from the date the cause of action accrues; or

(d)for life insurance or accident and health insurance, reserving discretionary authority.

(3)For purposes of Subsection (2)(c) , the cause of action accrues on a fidelity bond on the date the insurer first denies all or part of a claim made under the fidelity bond.

Amended by Chapter 351 , 2018 General Session