Code of Maine Rules
02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
031 - BUREAU OF INSURANCE
Chapter 420 - Nursing Home Care Insurance and Long-Term Care Insurance
Section 031-420-10 - Appealing a Claims Denial
Current through 2024-13, March 27, 2024
A. Representation. For purposes of this section and for section 11, "insured" includes the insured's authorized representative.
B. Notice. An insurer shall provide clear written notice to the insured of any claims denial. The notice shall include:
C. Standard Appeal. The insured may appeal the claims denial by sending a written request to the insurer within 120 days after receipt of the claims denial along with any additional supporting information. The internal appeal shall be considered by a panel of one or more qualified individuals, designated by the insurer, who did not participate in making the initial benefit determination.
D. Second Level Review