Section 3 AAC 28.586 - Prompt payment of clean claims(a) Not later than 30 days after receipt of a claim for benefits under a long-term care insurance policy or certificate, an insurer shall pay the claim if it is a clean claim, or send a written notice acknowledging the date of receipt of the claim and one of the following;(1) the insurer is declining to pay all or part of the claim and the specific reason or reasons for denial; or(2) that additional information is necessary to determine if all or a part of the claim is payable and the specific additional information that is necessary.(b) Not later than 30 days after receipt of all the requested additional information, an insurer shall pay a claim for benefits under a long-term care insurance policy or certificate if it is a clean claim, or send a written notice that the insurer is declining to pay all or part of the claim, and the specific reason or reasons for denial.(c) If an insurer fails to comply with (a) or (b) of this section, the insurer shall pay interest at the rate of 15 percent annually on the amount of the claim that should have been paid but that remains unpaid 30 days after the receipt of the claim with respect to (a) of this section or 15 days after receipt of all requested additional information with respect to (b) of this section. The interest payable under this subsection shall be included in a late reimbursement without requiring the person who filed the original claim to make an additional claim for the interest.(d) This section does not apply if the insurer has a reasonable basis supported by specific information that the claim was fraudulently submitted.(e) A violation of 3 AAC 28.550 - 3 AAC 28.599 by an insurer if committed flagrantly and in conscious disregard of the provisions of this section or with a frequency that constitutes a general business practice shall be considered a violation of AS 21.36.(f) To the extent there is a conflict, this section supersedes another claim payment requirement found in AS 21.36.495.(g) For purposes of this section, (1) "claim" means a request for payment of benefits under an in-force policy, regardless of whether the benefit claimed is covered under the policy or the terms or conditions of the policy have been met; and(2) "clean claim" means a claim that has no defect or impropriety, including the lack of required substantiating documentation, like satisfactory evidence of expenses incurred, or particular circumstance requiring special treatment that prevents timely payment from being made on the claim.Eff. 3/27/2022, Register 241, April 2022Authority:AS 21.06.090
AS 21.53.060
AS 21.53.090