S.D. Admin. R. 20:06:21:91
The insured or the insured's authorized representative may request an independent review of the insurer's benefit trigger determination after the internal appeal process outlined in §§ 20:06:21:89 and 20:06:21:90 has been exhausted. A written request for independent review may be made by the insured or the insured's authorized representative to the insurer within 120 calendar days after the insurer's written notice of the final internal appeal decision is received by the insured and insured's authorized representative, if applicable.
A rebuttable presumption that the notice was received by the insured within five days of mailing exists if the insurer can provide proof of actual properly addressed mailing or proof of standard office practice or procedure designed to ensure that items are properly addressed and mailed. If no proof of actual mailing or proof of standard office practice or procedure is provided, there is no presumption of receipt by the insured.
The cost of the independent review shall be borne by the insurer.
S.D. Admin. R. 20:06:21:91
General Authority: SDCL 58-17B-4.
Law Implemented: SDCL 58-17B-4.