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Ind. Code § 27-8-10-2.6

Member and health care provider grievances

Applied in 1 court decision — leading case Sun Life Assurance Co. of Canada v. Indiana Comprehensive Health Insurance Ass'n (2005)

Most recently applied in Sun Life Assurance Co. of Canada v. Indiana Comprehensive Health Insurance Ass'n (May 2005)

As added by P.L.51-2004, SEC.6.

Sec. 2.6. (a) If a:

(1) member is aggrieved by an act of the association; or

(2) health care provider is aggrieved by an act of the association with respect to reimbursement to the provider under an association policy;

the member or health care provider shall, not more than ninety (90) days after the act occurs, appeal to the board of directors for review of the act.

(b) If:

(1) within thirty (30) days after an appeal is filed under subsection (a), the board of directors has not acted on the appeal; or

(2) a member or health care provider is aggrieved by a final action or decision of the board of directors;

the member or health care provider may appeal to the commissioner.

(c) An appeal to the commissioner under subsection (b) must be filed less than thirty (30) days after the:

(1) expiration of the thirty (30) day period specified in subsection (b)(1); or

(2) action or decision specified in subsection (b)(2).

(d) The commissioner shall, not more than forty-five (45) days after an appeal is filed under subsection (c), take a final action or issue an order regarding the appeal.

(e) A final action or order of the commissioner on an appeal filed under this section is subject to judicial review.

(f) If a member or health care provider sues the association, the court shall not award to the member or health care provider:

(1) attorney's fees or costs; or

(2) punitive damages.

Official source: Indiana General Assembly. Reproduced from public-domain Indiana statutes; confirm against the official source for the current text. Not legal advice.