S.D. Admin. R. 20:06:21:93
If the insured or the insured's authorized representative has new or additional information not previously provided to the insurer, whether submitted to the insurer or the independent review organization, such information shall first be considered in the internal review process, as set forth in § 20:06:21:89. While this information is being reviewed by the insurer, the independent review organization shall suspend its review and the time period for review is suspended until the insurer completes its review.
The insurer shall complete its review of the information and provide written notice of the results of the review to the insured and the insured's authorized representative, if applicable, and the independent review organization within five business days of the insurer's receipt of such new or additional information.
If the insurer maintains its denial after such review, the independent review organization shall continue its review, and render its decision within the time period specified in § 20:06:21:99. If the insurer overturns its decision following its review, the independent review request shall be considered withdrawn.
S.D. Admin. R. 20:06:21:93
General Authority: SDCL 58-17B-4.
Law Implemented: SDCL 58-17B-4.