Arizona Statute | Act | Code |Insurance| US Code - US Statute

articles

Business Law

Incorporation of Company

Incorporation of LLC

Probate Law

Employment, Criminal and Labor

Family

Govt. agencies and Taxation

Courts

constitution

State Boundaries

Declaration of Rights

Distribution of powers

Legislative Department

More...

search a lawyer

Country:

City:

ACTS, STATUTES

Submit Article

Article Login

Find a Lawyer :
Country :

City :

Category :

Home > Statutes > Usa Arizona

USA Statutes : arizona
Title : Insurance
Chapter : HEALTH CARE INSURER LIABILITY

20-3151 Definitions
For the purposes of this section:
1. "Enrollee" means an individual who is enrolled in a health care plan provided by
a health care insurer.
2. "Health care insurer" means a disability insurer, group disability insurer,
blanket disability insurer, health care services organization, hospital service
corporation, medical service corporation or hospital and medical service corporation.
3. "Health care plan" means a policy, contract or evidence of coverage issued to an
enrollee. Health care plan does not include limited benefit coverage as defined in
section 20-1137.
4. "Health care professional" means a professional who is regulated pursuant to
title 32, chapter 7, 8, 11, 13, 14, 15, 15.1, 16, 17, 18, 19, 19.1, 25, 28, 29, 33, 34,
35, 39 or 41, title 36, chapter 6, article 7 or title 36, chapter 17.

20-3152 Exemptions; waiver
A. This chapter does not create:
1. Any liability on the part of any employer or employer group purchasing
organization that purchases coverage or assumes risk on behalf of its employees or on
behalf of self-funded employee benefit plans.
2. Any new or additional liability on the part of a health care insurer for harm
caused that is attributable to the medical negligence of a treating health care
professional or health care institution as defined in section 36-401.
B. This chapter does not abrogate or limit any other theory of liability or defense
otherwise available at law.
C. Any waiver by an enrollee of any provision of this chapter is contrary to public
policy and is unenforceable and void.
D. An enrollee who files an action pursuant to section 20-3153 may not pursue a
common law action for breach of the duty of good faith and fair dealing against the
health care insurer. An enrollee who files a common law action for breach of the duty of
good faith and fair dealing against a health care insurer may not pursue an action
pursuant to section 20-3153.

20-3153 Health care insurer liability
A. A health care insurer is liable for any damages caused to the insurer's enrollee
by the insurer's delay in authorizing or failure to authorize a request for medically
necessary health care services covered under the health care plan or by the insurer's
denial of payment of benefits covered under the health care plan if both:
1. The health care insurer delayed authorizing or failed to authorize the requested
health care services or denied payment of the covered benefits without a reasonable basis
for that action.
2. The health care insurer knew that it acted without a reasonable basis or failed
to perform an investigation or evaluation adequate to determine whether its action was
supported by a reasonable basis.
B. A health care insurer:
1. Is liable under this section if the insurer's conduct was a cause of the
enrollee's damages and if the damages would not have occurred without that conduct.
2. Is not liable under this section if the insurer's conduct under this section was
inadvertent or unintentional.

20-3154 Health care appeals; admissibility
In an action under this chapter, any person, enrollee or health care insurer may
introduce into evidence for any purpose any of the documents, findings, decisions or
information concerning events that occurred in the health care appeals process pursuant
to chapter 15, article 2 of this title. The fact that the enrollee did not participate in
the health care appeals process may also be introduced into evidence.

20-3155 Notice of intent to file suit
A. Before an enrollee files an action pursuant to section 20-3153, the enrollee
shall either:
1. Complete the health care appeals process prescribed in chapter 15, article 2 of
this title.
2. Provide written notice to the health care insurer at least thirty days before
filing suit stating the enrollee's intention to file suit and setting forth the basis for
the suit.
B. If the enrollee provides notice pursuant to subsection A, paragraph 2 of this
section, the enrollee shall deliver the notice to the health care insurer in compliance
with the terms specified for delivery of written notices prescribed in the policy,
contract or evidence of coverage. If the policy, contract or evidence of coverage does
not specify the terms for delivery of written notices, the enrollee may provide notice to
the last representative of the health care insurer who corresponded in writing with the
enrollee.
C. Participation in the health care appeals process prescribed in chapter 15,
article 2 of this title does not prohibit or limit the enrollee from filing suit at the
conclusion of the appeals process.

Usa-arizona Law Firm / Lawyers Services Provided in Usa-arizona :

Usa-arizona Divorce Laws, custody, Usa-arizona Corporate Lawyers, Agreement, provident fund, Registered marriage, Court marriage Lawyers, Special/ Foreign marriage, Incorporation of company, Rent, eviction, tenancy, Lease Lawyers, Usa-arizona Labour laws, Appeals, Supreme Court Lawyers, High Court Lawyers, Bail, medical, negligence, Insurance claims/ accidents Lawyer, Usa-arizona Citizenship/ immigration Lawyers, Copyright Laws, Consumer, district Lawyer, State, national, Dowry, Wills & Probate, Trust & Estates Lawyers, Intellectual Property Lawyer, Bankrupt Lawyers, Banking & Finance, Corporate, Private Business Law, Recovery, Joint Venture & Mergers, Consumer, Civil Right Law Usa-arizona, Medical Negligence, Medical Malpractice, legal notice, summons, Income Tax Lawyers, sales, Custom Law, Excise Law, octroi, cess Civil, Criminal Solicitor Usa-arizona, Registration of property, Title search, mutation relationship, Conveyance, Transfer of Property Law, Usa-arizona Property lawyer, deeds, drafts, power of attorney, Recovery, Taxation Laws in Usa-arizona

LEGAL SERVICES

Add Lawyer
Legal Enquiry
Find a Lawyer
Bare Acts / India Codes
Statutes / Code

LAWYER BY LOCATION

India Lawyer
United State Lawyer
UAE Lawyer
Canada Lawyer
Find More...

LAW PRACTICE AREA

Business Law
Employment & Labor Law
Govt. Agencis & Taxtion
Family Law
Real Estate Property Law
Immigration Law

ABOUT HELPLINELAW

About Us
Contact Us
Services
Site Map
Recommend to Friends

This web site is designed for general information only. The information presented at this site should not be construed to be formal legal advice nor the formation of a lawyer/client relationship. Persons accessing this site are encouraged to seek independent counsel for advice in India abroad regarding their individual legal, civil criminal issues or consult one of the experts online.