Has your insurance carrier been stalling you on paying for your submitted claim? Have you submitted all the required documentation and have yet to hear back from them? As frustrating as this may be, it isn’t exactly rare behavior from an insurance company. Many insurers, including those in the field of property, health, and auto will delay the payout of a claim, which can leave you with having to spend more of your hard-earned money. But, this isn’t something you have to deal with. Because the South Dakota Legislature has codified laws that are currently active, your insurance companies do have timelines they need to abide by. And when they don’t, you may be required to hire one of our dedicated South Dakota insurance claim dispute lawyers who can get involved and determine what is delaying your claim payout.
What Laws Do My Insurance Companies Need to Abide by?
As mentioned, there is a deadline your insurance carrier is required to abide by given that your claim is a “clean claim.” According to § 58-12-19 a clean claim is defined as “a claim for which there is no need for additional information to determine eligibility or adjudicate the claim. The term, clean claim, does not include a claim for payment of expenses incurred during a period of time for which premiums are delinquent, except to the extent otherwise required by law or a claim for which fraud is suspected.”
Time Limits for Processing a Clean Claim When Additional Information is Required
According to § 58-12-20, each clean claim that is submitted should be paid, denied, or settled within 30 calendar days after the insurer has received the claim electronically. They have 45 calendar days if the claim was received by another form of submission given that the claim is payable under the plan.
Sometimes, your insurance carrier is going to require additional information after the initial submission of claim. In the event they do, they have 30 calendar days after receipt of the claim to “give the provider, policyholder, insured, or patient, as appropriate, a full explanation of what additional information is needed in order to determine eligibility or adjudicate the claim.” The individual who is has received this request for additional information must provide their insurer with it within 30 calendar days. The person receiving a request for additional information shall submit all information requested after receipt of such request.
While some insurance companies will pay out what is rightfully due to the claimant, sometimes they provide a lower settlement amount or fail to comply with the deadlines that have been set in the codified laws of South Dakota. What you need to be mindful of is that you have rights as a policy holder and you should exercise them when necessary.
Certain insurance claims including those involving damage to your home or vehicle can be rather expensive and if you had to pay the money up front to cover the damage, you are going to want it back in a timely manner.