NRS 689A.410
Approval or denial of claims

  • payment of claims and interest
  • requests for additional information
  • award of costs and attorney’s fees
  • compliance with requirements
  • imposition of administrative fine or suspension or revocation of certificate of authority for failure to comply.

1.

Except as otherwise provided in subsection 2, an insurer shall approve or deny a claim relating to a policy of health insurance within 30 days after the insurer receives the claim. If the claim is approved, the insurer shall pay the claim within 30 days after it is approved. Except as otherwise provided in this section, if the approved claim is not paid within that period, the insurer shall pay interest on the claim at a rate of interest equal to the prime rate at the largest bank in Nevada, as ascertained by the Commissioner of Financial Institutions, on January 1 or July 1, as the case may be, immediately preceding the date on which the payment was due, plus 6 percent. The interest must be calculated from 30 days after the date on which the claim is approved until the date on which the claim is paid.

2.

If the insurer requires additional information to determine whether to approve or deny the claim, it shall notify the claimant of its request for the additional information within 20 days after it receives the claim. The insurer shall notify the provider of health care of all the specific reasons for the delay in approving or denying the claim. The insurer shall approve or deny the claim within 30 days after receiving the additional information. If the claim is approved, the insurer shall pay the claim within 30 days after it receives the additional information. If the approved claim is not paid within that period, the insurer shall pay interest on the claim in the manner prescribed in subsection 1.

3.

An insurer shall not request a claimant to resubmit information that the claimant has already provided to the insurer, unless the insurer provides a legitimate reason for the request and the purpose of the request is not to delay the payment of the claim, harass the claimant or discourage the filing of claims.

4.

An insurer shall not pay only part of a claim that has been approved and is fully payable.

5.

A court shall award costs and reasonable attorney’s fees to the prevailing party in an action brought pursuant to this section.

6.

The payment of interest provided for in this section for the late payment of an approved claim may be waived only if the payment was delayed because of an act of God or another cause beyond the control of the insurer.

7.

The Commissioner may require an insurer to provide evidence which demonstrates that the insurer has substantially complied with the requirements set forth in this section, including, without limitation, payment within 30 days of at least 95 percent of approved claims or at least 90 percent of the total dollar amount for approved claims.

8.

If the Commissioner determines that an insurer is not in substantial compliance with the requirements set forth in this section, the Commissioner may require the insurer to pay an administrative fine in an amount to be determined by the Commissioner. Upon a second or subsequent determination that an insurer is not in substantial compliance with the requirements set forth in this section, the Commissioner may suspend or revoke the certificate of authority of the insurer.

Source: Section 689A.410 — Approval or denial of claims; payment of claims and interest; requests for additional information; award of costs and attorney’s fees; compliance with requirements; imposition of administrative fine or suspension or revocation of certificate of authority for failure to comply., https://www.­leg.­state.­nv.­us/NRS/NRS-689A.­html#NRS689ASec410.

689A.050
Entire contract 689A.060
Time limit on certain defenses. 689A.070
Grace period. 689A.075
Cancellation and rescission of short-term limited duration medical plan. 689A.080
Reinstatement. 689A.090
Notice of claim. 689A.100
Claim forms: Required provision. 689A.105
Claim forms: Uniform billing, claims forms. 689A.110
Claim forms: Acceptance of uniform forms. 689A.120
Time of payment of claims. 689A.130
Payment of claims. 689A.135
Assignment of benefits to provider of health care. 689A.140
Physical examination and autopsy. 689A.150
Legal actions. 689A.160
Change of beneficiary. 689A.170
Right to examine and return policy. 689A.180
Optional provisions. 689A.190
Extended disability benefit. 689A.200
Change of occupation. 689A.210
Misstatement of age. 689A.220
Coordination of benefits: Same insurer. 689A.230
Coordination of benefits: All coverages. 689A.240
Relation of earnings to insurance. 689A.250
Unpaid premiums. 689A.260
Conformity with state statutes. 689A.270
Illegal occupation. 689A.290
Renewability. 689A.300
Order of certain provisions. 689A.310
Ownership of policy by person other than insured. 689A.320
Requirements of other jurisdictions. 689A.330
Policies issued for delivery in another state. 689A.340
Limitation on provisions not subject to chapter 689A.350
Age limit. 689A.380
Definitions of terms used in policies. 689A.390
Summary of coverage: Contents of disclosure 689A.400
Summary of coverage: Copy to be provided before policy issued 689A.405
Coverage for prescription drugs: Provision of notice and information regarding use of formulary. 689A.410
Approval or denial of claims 689A.413
Insurer prohibited from denying coverage solely because person was victim of domestic violence. 689A.415
Insurer prohibited from denying coverage solely because insured was intoxicated or under influence of controlled substance 689A.417
Insurer prohibited from requiring or using information concerning genetic testing 689A.419
Offering policy of health insurance for purposes of establishing health savings account.
Last Updated

Jun. 24, 2021

§ 689A.410’s source at nv​.us